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Tono K, Nishida T, Matsumoto K, Yamashita M, Sugimoto A, Nakamatsu D, Yamamoto M, Tamura H, Shimizu J, Fukui K. A case of pancreatic arteriovenous malformation diagnosed after the onset of abdominal symptoms. Clin J Gastroenterol 2025; 18:470-475. [PMID: 40032769 DOI: 10.1007/s12328-025-02104-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2024] [Accepted: 02/05/2025] [Indexed: 03/05/2025]
Abstract
Pancreatic arteriovenous malformation (P-AVM) is an extremely rare vascular anomaly characterized by abnormal connections between arteries and veins bypassing the capillary network. Less than 200 cases have been reported worldwide, and standardized treatment guidelines have not yet been established. A 72-year-old man presented with abdominal distension, diarrhea, and appetite loss. Contrast-enhanced abdominal computed tomography revealed a 5 cm mass in the pancreatic tail with multiple feeding and draining vessels, a portosystemic shunt, and moderate ascites, suggesting a P-AVM. Endoscopic ultrasonography revealed a hypoechoic area in the pancreatic tail measuring 50 mm in diameter. Esophagogastroduodenoscopy revealed F2-type esophageal varices. Based on imaging findings and clinical history, the patient was diagnosed with P-AVM, and Osler-Weber-Rendu disease was excluded. Initial treatment with transarterial embolization was attempted, but proved insufficient due to high blood flow and multiple feeders. Surgical resection via distal pancreatectomy was subsequently performed to alleviate portal hypertension and resolve abdominal symptoms, although significant intraoperative bleeding occurred. This case highlights the diagnostic and therapeutic challenges of P-AVMs, particularly in high-flow lesions with complex vascular anatomy. Surgical resection remains the definitive treatment for symptomatic P-AVM and effectively resolves the associated complications. The insights gained from this case may contribute to the clinical management of this rare condition.
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Affiliation(s)
- Katsuharu Tono
- Department of Gastroenterology, Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, Osaka, 560-8565, Japan
| | - Tsutomu Nishida
- Department of Gastroenterology, Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, Osaka, 560-8565, Japan.
| | - Kengo Matsumoto
- Department of Gastroenterology, Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, Osaka, 560-8565, Japan
| | - Masafumi Yamashita
- Department of Gastroenterological Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | - Aya Sugimoto
- Department of Gastroenterology, Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, Osaka, 560-8565, Japan
| | - Dai Nakamatsu
- Department of Gastroenterology, Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, Osaka, 560-8565, Japan
| | - Masashi Yamamoto
- Department of Gastroenterology, Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, Osaka, 560-8565, Japan
| | - Hiromi Tamura
- Department of Pathology, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | - Junzo Shimizu
- Department of Gastroenterological Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | - Koji Fukui
- Department of Gastroenterology, Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, Osaka, 560-8565, Japan
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Liu J, Xue X, Lin S, Yang L, Zhou S. Pancreatic arteriovenous malformation: A case report. Medicine (Baltimore) 2025; 104:e42427. [PMID: 40355214 PMCID: PMC12073968 DOI: 10.1097/md.0000000000042427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Accepted: 11/25/2024] [Indexed: 05/14/2025] Open
Abstract
RATIONALE Pancreatic arteriovenous malformation (PAVM) is predominantly caused by congenital factors and is an extremely rare vascular anomaly. The number of documented and reported cases in the literature remains very low. PATIENT CONCERNS We report a case of a 37-year-old male who was admitted to the hospital due to acute abdominal pain. DIAGNOSES Computed tomography revealed an arteriovenous malformation in the tail of the pancreas and acute pancreatitis. INTERVENTIONS The patient underwent a distal pancreatectomy combined with splenectomy. OUTCOMES Histopathological examination confirmed the presence of an arteriovenous malformation in the tail of the pancreas along with acute pancreatitis. We believe that the acute pancreatitis was induced by the PAVM. The patient was discharged successfully and remained symptom-free during follow-up. LESSONS PAVM is a rare vascular abnormality occurring in the pancreas. Clinical manifestations can include gastrointestinal bleeding, intra-abdominal hemorrhage, pancreatitis, portal hypertension, and pancreatic pseudocyst. Diagnosis can be confirmed through ultrasound, contrast-enhanced computed tomography, magnetic resonance imaging, and digital subtraction angiography. Surgical treatment is an effective approach for symptomatic PAVM.
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Affiliation(s)
- Jianping Liu
- Department of General Surgery, Dongnan Hospital of Xiamen University, School of Medicine, Xiamen University, Zhangzhou, China
| | - Xiaojun Xue
- Department of General Surgery, Dongnan Hospital of Xiamen University, School of Medicine, Xiamen University, Zhangzhou, China
| | - Songrong Lin
- Department of General Surgery, Dongnan Hospital of Xiamen University, School of Medicine, Xiamen University, Zhangzhou, China
| | - Liming Yang
- Department of Pathology, Dongnan Hospital of Xiamen University, School of Medicine, Xiamen University, Zhangzhou, China
| | - Song Zhou
- Department of General Surgery, Dongnan Hospital of Xiamen University, School of Medicine, Xiamen University, Zhangzhou, China
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Iwata S, Iwashita T, Senju A, Tezuka R, Uemura S, Fukada M, Murase K, Matsuhashi N, Saigo C, Miyazaki T, Shimizu M. Successful Surgical Resection of Pancreatic Arteriovenous Malformation Complicated by Acute Pancreatitis. Intern Med 2025; 64:839-844. [PMID: 39231680 PMCID: PMC11986322 DOI: 10.2169/internalmedicine.3699-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 07/11/2024] [Indexed: 09/06/2024] Open
Abstract
A 73-year-old man presented with left hypochondral pain. Dynamic computed tomography (CT) revealed abnormal vessels surrounding the pancreas, leading to a suspected diagnosis of pancreatic arteriovenous malformation (PAVM). At the time of the initial examination, dynamic CT revealed mild acute pancreatitis, and PAVM was diagnosed based on the findings of dynamic CT. Although repeated abdominal pain was observed after the improvement of pancreatitis, distal pancreatectomy was performed. At >1 year after surgery, no recurrence of PAVM was observed. Surgical resection should be considered in patients with symptomatic PAVM.
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Affiliation(s)
- Shota Iwata
- First Department of Internal Medicine, Gifu University Hospital, Japan
| | - Takuji Iwashita
- First Department of Internal Medicine, Gifu University Hospital, Japan
| | - Akihiko Senju
- First Department of Internal Medicine, Gifu University Hospital, Japan
| | - Ryuichi Tezuka
- First Department of Internal Medicine, Gifu University Hospital, Japan
| | - Shinya Uemura
- First Department of Internal Medicine, Gifu University Hospital, Japan
| | - Masahiro Fukada
- Department of Gastroenterological Surgery ・ Pediatric Surgery, Gifu University Hospital, Japan
| | - Katsutoshi Murase
- Department of Gastroenterological Surgery ・ Pediatric Surgery, Gifu University Hospital, Japan
| | - Nobuhisa Matsuhashi
- Department of Gastroenterological Surgery ・ Pediatric Surgery, Gifu University Hospital, Japan
| | - Chiemi Saigo
- Department of Pathology, Gifu University Hospital, Japan
| | | | - Masahito Shimizu
- First Department of Internal Medicine, Gifu University Hospital, Japan
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Shin SH, Cho CK, Yu SY. Pancreatic arteriovenous malformation treated with transcatheter arterial embolization: Two case reports and review of literature. World J Clin Cases 2023; 11:6920-6930. [PMID: 37901023 PMCID: PMC10600833 DOI: 10.12998/wjcc.v11.i28.6920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/09/2023] [Accepted: 09/05/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Various treatment methods are available for the treatment of pancreatic arteriovenous malformation (P-AVM); however, there are no established treatment options for asymptomatic P-AVM. CASE SUMMARY A 47-year-old and a 50-year-old male patients sought treatment for P-AVM in the pancreas, which was incidentally detected during routine abdominal computed tomography and magnetic resonance imaging conducted as part of a health check-up. They underwent transcatheter arterial embolization (TAE), and over the course of a 9-year follow-up period, the AVM did not worsen and was asymptomatic. CONCLUSION TAE can be considered as an alternative treatment option for P-AVM in selective cases where patients are asymptomatic or have a high surgical risk.
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Affiliation(s)
- Sang Hoon Shin
- Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun 58128, Jeollanam-do, South Korea
| | - Chol Kyoon Cho
- Department of Surgery, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun 58128, Jeollanam-do, South Korea
| | - Sung Yeol Yu
- Department of Surgery, Chonnam National University Hospital, Gwangju 61469, South Korea
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Onozawa S, Miyauchi R, Takahashi M, Kuroki K. An Update of Treatment of Pancreatic Arteriovenous Malformations. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2023; 8:49-55. [PMID: 37485485 PMCID: PMC10359168 DOI: 10.22575/interventionalradiology.2022-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 02/19/2023] [Indexed: 07/25/2023]
Abstract
Pancreatic arteriovenous malformation is a rare entity (0.9%). There are about 200 articles available in PubMed. This review article includes 86 published articles, with 117 cases published after 2000. The median age at diagnosis was 51, and most of the patients were male (87.0%). The symptoms included pain, bleeding, pancreatitis, ulcers in the duodenum or stomach, varix formation, jaundice, and ascites. The diagnostic modalities were angiography, contrast-enhanced CT, MRI, and/or Ultra Sound. The most common treatments were surgery and embolization. The clinical success rate of embolization reported was 57.7%. The tailored embolization based on each agio-architecture had a clinical success rate of 80%. If embolic therapy is ineffective, surgical intervention should be considered.
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Affiliation(s)
- Shiro Onozawa
- Department of Radiology, Kyorin University, Faculty of Medicine, Japan
| | - Ryosuke Miyauchi
- Department of Radiology, Kyorin University, Faculty of Medicine, Japan
| | - Masaki Takahashi
- Department of Radiology, Kyorin University, Faculty of Medicine, Japan
| | - Kazunori Kuroki
- Department of Radiology, Kyorin University, Faculty of Medicine, Japan
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Kitazono M, Fujita M, Katsue K, Ikeda N, Oyama T, Eguchi M, Kamimura G, Sato R, Uchiyama S, Toyosaki R, Suenaga T. A case of emergency pancreatoduodenectomy for bleeding from the duodenal mucosa due to arteriovenous malformation of the pancreatic head. Clin Case Rep 2021; 9:e04824. [PMID: 34584707 PMCID: PMC8455972 DOI: 10.1002/ccr3.4824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 11/08/2022] Open
Abstract
A rare case of bleeding from the duodenal mucosa due to arteriovenous malformation of the pancreatic head is reported. Caution needs to be observed, then excision may be necessary since noninvasive treatment such as coil embolization is not enough for complete hemostasis when patient suddenly decompensates.
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Affiliation(s)
- Masaki Kitazono
- Department of SurgeryPublic Interest Incorporated AssociationKagoshima KyosaikaiNanpuh HospitalKagoshima CityJapan
| | - Makoto Fujita
- Division of Medical SupportPublic Interest Incorporated AssociationKagoshima KyosaikaiNanpuh HospitalKagoshima CityJapan
| | - Katsugi Katsue
- Department of SurgeryPublic Interest Incorporated AssociationKagoshima KyosaikaiNanpuh HospitalKagoshima CityJapan
| | - Naotaka Ikeda
- Department of SurgeryPublic Interest Incorporated AssociationKagoshima KyosaikaiNanpuh HospitalKagoshima CityJapan
| | - Tomohiro Oyama
- Department of SurgeryPublic Interest Incorporated AssociationKagoshima KyosaikaiNanpuh HospitalKagoshima CityJapan
| | - Mayumi Eguchi
- Department of SurgeryPublic Interest Incorporated AssociationKagoshima KyosaikaiNanpuh HospitalKagoshima CityJapan
| | - Go Kamimura
- Department of SurgeryPublic Interest Incorporated AssociationKagoshima KyosaikaiNanpuh HospitalKagoshima CityJapan
| | - Rikiya Sato
- Department of SurgeryPublic Interest Incorporated AssociationKagoshima KyosaikaiNanpuh HospitalKagoshima CityJapan
| | - Shuichiro Uchiyama
- Department of SurgeryPublic Interest Incorporated AssociationKagoshima KyosaikaiNanpuh HospitalKagoshima CityJapan
| | - Ryoichi Toyosaki
- Department of SurgeryPublic Interest Incorporated AssociationKagoshima KyosaikaiNanpuh HospitalKagoshima CityJapan
| | - Toyokuni Suenaga
- Department of SurgeryPublic Interest Incorporated AssociationKagoshima KyosaikaiNanpuh HospitalKagoshima CityJapan
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Abiko T, Ebihara Y, Takeuchi M, Sakamoto H, Takahashi M, Homma H, Hirano S. Laparoscopic distal pancreatectomy for pancreatic arteriovenous malformation complicated with portal hypertension. J Minim Access Surg 2021; 17:373-375. [PMID: 33885019 PMCID: PMC8270048 DOI: 10.4103/jmas.jmas_193_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Pancreatic arteriovenous malformation (PAVM) is defined as a vascular anomaly with an abnormal anastomosis of the arterial and portal networks within the pancreas. Treatment modalities of PAVM include transarterial embolisation (TAE), irradiation and operation. Most patients treated with TAE alone will experience recurrence, so surgery is the best radical treatment. A female patient was admitted to our institution for the treatment of haematemesis. Examination revealed varices in the oesophagus and stomach, collateral circulation development caused by portal hypertension and PAVM of the pancreas. Surgical treatment was intended to reduce left portal hypertension. In this case, collateral circulation were considered dangerous points for unexpected bleeding. TAE was performed on the splenic artery before surgery to reduce blood flow in the areas with collateral circulation. En bloc resection of retroperitoneal tissue using the surgical procedure of radical antegrade modular pancreatosplenectomy was effective to minimise blood loss.
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Affiliation(s)
- Takehiro Abiko
- Gastroenterological Surgery, Spporo Kyoritsu Gorinbashi Hospital; Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Yuma Ebihara
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University; Division of Minimally Invasive Surgery, Hokkaido University Hospital, Sapporo, Japan
| | - Motoya Takeuchi
- Gastroenterological Surgery, Spporo Kyoritsu Gorinbashi Hospital, Sapporo, Japan
| | - Hiroki Sakamoto
- Gastroenterology, Spporo Kyoritsu Gorinbashi Hospital, Sapporo, Japan
| | - Minoru Takahashi
- Gastroenterology, Spporo Kyoritsu Gorinbashi Hospital, Sapporo, Japan
| | - Hisato Homma
- Gastroenterology, Spporo Kyoritsu Gorinbashi Hospital, Sapporo, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
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8
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Korai T, Kimura Y, Imamura M, Nagayama M, Kanazawa A, Miura R, Murakami T, Kyuno D, Yamaguchi H, Terai K, Sugita S, Nobuoka T, Hasegawa T, Takemasa I. Arteriovenous malformation in the pancreatic head initially mimicking a hypervascular mass treated with duodenum-preserving pancreatic head resection: a case report. Surg Case Rep 2020; 6:301. [PMID: 33259015 PMCID: PMC7708544 DOI: 10.1186/s40792-020-01075-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/18/2020] [Indexed: 01/08/2023] Open
Abstract
Background The mainstay treatment for arteriovenous malformation in the pancreatic head (Ph-AVM) is standard pancreatectomy, especially pancreaticoduodenectomy (PD), or interventional endovascular treatment. We report the first case of Ph-AVM treated with duodenum-preserving pancreatic head resection (DPPHR) performed to preserve the periampullary organs. Case presentation A 59-year-old man presenting with back pain underwent contrast-enhanced computed tomography followed by angiography of the anterior superior pancreaticoduodenal artery. He was diagnosed with Ph-AVM and indicated for DPPHR with preservation of the periampullary organs; Ph-AVM’s benign nature seldom requires lymph node dissection. During the operation, the right colon was mobilized and the omental bursa was released to expose the periampullary structures. The pancreas was transected just above the superior mesenteric vein. The inferior pancreaticoduodenal artery and papillary arteries branching from the posterior superior pancreaticoduodenal artery were carefully preserved to maintain the blood flow to the lower bile duct and papilla of Vater. The remnant pancreas was reconstructed with pancreaticogastrostomy using the modified Blumgart method. Pathological examination of the resected specimen revealed an irregular course of the arteries and veins concomitant with marked dilation throughout the pancreatic head. The patient was pathologically diagnosed with Ph-AVM. He developed hematemesis caused by a rupture of the pseudoaneurysm on postoperative day 20 and underwent coil embolization. A bilio-enteric fistula and stenosis of the common bile duct were found and treated by placement of an endoscopic biliary stent. At the 8-month follow-up, the Ph-AVM had not recurred. Conclusions Compared to PD, DPPHR confers the clinical benefit of preserving the periampullary organs, although further studies are needed to confirm this. Therefore, the choice of this procedure should be based on the surgical morbidities and long-term outcome of the patient.
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Affiliation(s)
- Takahiro Korai
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 Minami-1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Yasutoshi Kimura
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 Minami-1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
| | - Masafumi Imamura
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 Minami-1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Minoru Nagayama
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 Minami-1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Ayumi Kanazawa
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 Minami-1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Ryo Miura
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 Minami-1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Takeshi Murakami
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 Minami-1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Daisuke Kyuno
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 Minami-1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Hiroshi Yamaguchi
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 Minami-1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Kotomi Terai
- Surgical Pathology, Sapporo Medical University School of Medicine, 291 Minami-1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Shintaro Sugita
- Surgical Pathology, Sapporo Medical University School of Medicine, 291 Minami-1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Takayuki Nobuoka
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 Minami-1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Tadashi Hasegawa
- Surgical Pathology, Sapporo Medical University School of Medicine, 291 Minami-1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Ichiro Takemasa
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 Minami-1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
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9
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Takayama H, Shimodate Y, Nomura S, Kitagawa H, Akaike Y, Uchino K, Watanabe T, Mizuno M. Bleeding from pancreatic arteriovenous malformation with duodenal ulcer penetration. Case report and literature review. Clin Case Rep 2020; 8:1472-1475. [PMID: 32884777 PMCID: PMC7455445 DOI: 10.1002/ccr3.2888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 02/21/2020] [Accepted: 03/29/2020] [Indexed: 11/19/2022] Open
Abstract
Dilated vessels at the ulcer floor of the second part of the duodenum can be signs of pancreatic arteriovenous malformation; contrast-enhanced computed tomography should be performed, and surgical treatment should be considered.
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Affiliation(s)
- Hiroshi Takayama
- Department of GastroenterologyKurashiki Central HospitalOkayamaJapan
| | - Yuichi Shimodate
- Department of GastroenterologyKurashiki Central HospitalOkayamaJapan
| | - Satoshi Nomura
- Department of SurgeryKurashiki Central HospitalOkayamaJapan
| | | | - Yoko Akaike
- Department of PathologyKurashiki Central HospitalOkayamaJapan
| | - Kaori Uchino
- Department of PathologyKurashiki Central HospitalOkayamaJapan
| | - Tetsuo Watanabe
- Department of SurgeryWatanabe Ichoka‐geka HospitalOkayamaJapan
| | - Motowo Mizuno
- Department of GastroenterologyKurashiki Central HospitalOkayamaJapan
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10
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Yoon SY, Jeon GS, Lee SJ, Kim DJ, Kwon CI, Park MH. Embolization of pancreatic arteriovenous malformation: A case report. World J Clin Cases 2020; 8:1471-1476. [PMID: 32368539 PMCID: PMC7190961 DOI: 10.12998/wjcc.v8.i8.1471] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/09/2020] [Accepted: 04/16/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pancreatic arteriovenous malformation (AVM) is a rare disease with a number of different reported treatment methods, but there are as yet no established or definite treatments for the disease.
CASE SUMMARY A 43-year-old man visited the hospital due to periumbilical pain. The patient underwent imaging study and laboratory testing for evaluation of cause. Pancreatic AVM associated with pancreatitis was suspected on computed tomography and magnetic resonance imaging. The patient was diagnosed with pancreatic AVM with pancreatitis on imaging study and angiography. Transcatheter arterial embolization with various embolic materials was performed. Follow-up computed tomography scan revealed progressive regression of AVM and improvement of pancreatitis. At two-year follow-up, the patient showed no recurrence of symptom or pancreatitis.
CONCLUSION Transcatheter arterial embolization can be considered an effective treatment modality for selective cases of pancreatic AVM.
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Affiliation(s)
- So Yeon Yoon
- Department of Radiology, CHA Bundang Medical Center, College of Medicine, CHA University, Seongnam-si 13496, Gyeonggi-do, South Korea
| | - Gyeong Sik Jeon
- Department of Radiology, CHA Bundang Medical Center, College of Medicine, CHA University, Seongnam-si 13496, Gyeonggi-do, South Korea
| | - Shin Jae Lee
- Department of Radiology, Research Institute of Radiological Science, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si 17046, South Korea
| | - Dae Joong Kim
- Department of Radiology, CHA Bundang Medical Center, College of Medicine, CHA University, Seongnam-si 13496, Gyeonggi-do, South Korea
| | - Chang Il Kwon
- Department of Internal Medicine, Digestive Disease Center, CHA Bundang Medical Center, College of Medicine, CHA University, Seongnam-si 13496, Gyeonggi-do, South Korea
| | - Mi Hyun Park
- Department of Radiology, Dankook University Hospital, Chungcheongnam-do 31116, South Korea
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11
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Ishigami K, Sakuma T, Saito M, Kawakami Y, Masaki Y, Murota A, Motoya M, Kimura Y, Nakase H. Arteriovenous malformation in pancreas mimicking hypervascular tumor. JGH OPEN 2020; 4:773-774. [PMID: 32782971 PMCID: PMC7411645 DOI: 10.1002/jgh3.12343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 11/09/2022]
Abstract
Arteriovenous malformation (AVM) is defined as a disease that causes blood flow abnormality due to anastomoses of the arteries and veins. AVM can occur in any gastrointestinal tract, but pancreatic AVM (P-AVM) is very rare. Previous reports demonstrated that contrast-enhanced CT (CECT) typically showed abnormal vascular network in pancreas. We present a 58-year old man with a history of acute pancreatitis. He was referred to our hospital for examination of pancreatic mass. CECT showed a round-shaped hypervascular lesion with a diameter of 8 mm in the head of the pancreas. Selective angiography showed vascular network and early visualization of superior mesenteric vein. We finally diagnosed this case as P-AVM. He underwent duodenum preserving pancreatic head resection. Histological findings confirmed the preoperative diagnosis of P-AVM.
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Affiliation(s)
- Keisuke Ishigami
- Department of Gastroenterology and Hepatology Sapporo Medical University School of Medicine Sapporo Japan
| | - Tomoya Sakuma
- Sapporo Medical University School of Medicine Sapporo Japan
| | - Masato Saito
- Department of Radiology Oncology Sapporo Medical University School of Medicine Sapporo Japan
| | - Yujiro Kawakami
- Department of Gastroenterology and Hepatology Sapporo Medical University School of Medicine Sapporo Japan
| | - Yoshiharu Masaki
- Department of Gastroenterology and Hepatology Sapporo Medical University School of Medicine Sapporo Japan
| | - Ayako Murota
- Department of Gastroenterology and Hepatology Sapporo Medical University School of Medicine Sapporo Japan
| | - Masayo Motoya
- Department of Gastroenterology and Hepatology Sapporo Medical University School of Medicine Sapporo Japan
| | - Yasutoshi Kimura
- Department of Surgery, Surgical Oncology and Science Sapporo Medical University School of Medicine Sapporo Japan
| | - Hiroshi Nakase
- Department of Gastroenterology and Hepatology Sapporo Medical University School of Medicine Sapporo Japan
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12
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Sellier J, Karam C, Beauchet A, Dallongeville A, Binsse S, Blivet S, Bourgault-Villada I, Charron P, Chinet T, Eyries M, Fagnou C, Lesniak J, Lesur G, Lucas J, Nicod-Tran A, Ozanne A, Palmyre A, Soubrier F, El Hajjam M, Lacombe P. Higher prevalence of splenic artery aneurysms in hereditary hemorrhagic telangiectasia: Vascular implications and risk factors. PLoS One 2020; 15:e0226681. [PMID: 31971937 PMCID: PMC6977744 DOI: 10.1371/journal.pone.0226681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 12/02/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Splenic artery aneurysm (SAA) is a rare but potentially fatal condition. Rupture results in 25% mortality up to 75% in pregnant women with 95% fetal mortality. Brief reports suggest an increased risk of developing SAA in patients with HHT. METHODS We analyzed enhanced multidetector CT data in 186 HHT patients matched (gender and ± 5 year old) with 186 controls. We screened for SAA and recorded diameter of splenic and hepatic arteries and hepatic, pancreatic and splenic parenchymal involvements. We determined by univariate and multivariate analysis, the relationship with age, sex, genetic status, cardiovascular risk factors (CVRF) and visceral involvement. RESULTS SAA concerned 24.7% of HHT patients and 5.4% of controls, p<0.001. Factors associated with increased risk of SAA in HHT were female gender (p = 0.04, OR = 2.12, IC 95% = 1.03-4.50), age (p = 0.0003, OR = 1.04, 95% CI = 1.02-1.06) and pancreatic parenchymal involvement (p = 0.04, OR = 2.13, 95% CI = 1.01-4.49), but not type of mutation, hepatic or splenic parenchymal involvements, splenic size or splenic artery diameter or CVRF. CONCLUSIONS We found a 4.57 higher rate of SAA in HHT patients without evidence of splenic high output related disease or increased CVRF. These results suggest the presence of a vascular intrinsic involvement. It should lead to screening all HHT patients for SAA. The vasculopathy hypothesis could require a change in management as screening of all systemic arteries and even the aorta and to further research in the field.
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Affiliation(s)
- Jacques Sellier
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Carma Karam
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
- * E-mail:
| | - Alain Beauchet
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Axel Dallongeville
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Stephen Binsse
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Sandra Blivet
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Isabelle Bourgault-Villada
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Philippe Charron
- Pitié-Salpêtrière Hospital, Department of Genetics, AP-HP, Paris, France
| | - Thierry Chinet
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Mélanie Eyries
- Pitié-Salpêtrière Hospital, Department of Genetics, AP-HP, Paris, France
| | - Carole Fagnou
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Jérome Lesniak
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Gilles Lesur
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Jérome Lucas
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Agnès Nicod-Tran
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Augustin Ozanne
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Aurélien Palmyre
- Pitié-Salpêtrière Hospital, Department of Genetics, AP-HP, Paris, France
| | - Florent Soubrier
- Pitié-Salpêtrière Hospital, Department of Genetics, AP-HP, Paris, France
| | - Mostafa El Hajjam
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Pascal Lacombe
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
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13
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Ochiai S, Tomita K, Nakagawa M, Koganezawa I, Yokozuka K, Gunji T, Hikita K, Ozawa Y, Kobayashi T, Sano T, Tsutsui R, Chiba N, Wakiya M, Hirano H, Kawachi S. Resection of a pancreatic capillary lymphatic malformation through a partial pancreatectomy: a case report. Surg Case Rep 2019; 5:48. [PMID: 30923959 PMCID: PMC6439066 DOI: 10.1186/s40792-019-0603-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/12/2019] [Indexed: 11/29/2022] Open
Abstract
Background Pancreatic vascular malformation causes epigastric pain, pancreatitis, portal vein hypertension, bleeding, and rupture. It is a rare disease, with most pancreatic vascular malformations being arteriovenous malformations (AVMs) and the other types of malformations being rare. We report a case of capillary lymphatic malformation (CLM) in the pancreatic uncinate process. Case presentation A 74-year-old woman, who presented with complaints of repeated upper abdominal pain, was admitted to our institution. Contrast-enhanced dynamic computed tomography (CT) scan revealed that the tumor in the pancreatic uncinate process had a poor contrast effect in the arterial phase and a small contrast effect in the equilibrium phase, which are suggestive of a benign disease-like vascular malformation. However, we suspected that it could possibly be a malignant tumor because the tumor size tended to increase over time; thus, we decided to perform a surgery. We resected the tumor through a partial resection of the pancreas. Macroscopically, the cut surface of the tumor had a spongioid appearance. Histopathological examination findings showed a mixed shape of small capillaries and lymphatic ducts. The patient was diagnosed with CLM according to the International Society for the Study of Vascular Anomalies (ISSVA) classification, based on the histological appearance and immunostaining findings. The postoperative course of the patient was uneventful. Conclusions We reported a case of pancreatic vascular malformation, specifically a CLM, which was completely resected through a partial pancreatectomy.
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Affiliation(s)
- Shigeto Ochiai
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachiojishi, Tokyo, 193-0998, Japan
| | - Koichi Tomita
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachiojishi, Tokyo, 193-0998, Japan.
| | - Masashi Nakagawa
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachiojishi, Tokyo, 193-0998, Japan
| | - Itsuki Koganezawa
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachiojishi, Tokyo, 193-0998, Japan
| | - Kei Yokozuka
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachiojishi, Tokyo, 193-0998, Japan
| | - Takahiro Gunji
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachiojishi, Tokyo, 193-0998, Japan
| | - Kosuke Hikita
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachiojishi, Tokyo, 193-0998, Japan
| | - Yosuke Ozawa
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachiojishi, Tokyo, 193-0998, Japan
| | - Toshimichi Kobayashi
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachiojishi, Tokyo, 193-0998, Japan
| | - Toru Sano
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachiojishi, Tokyo, 193-0998, Japan
| | - Rina Tsutsui
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachiojishi, Tokyo, 193-0998, Japan
| | - Naokazu Chiba
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachiojishi, Tokyo, 193-0998, Japan
| | - Midori Wakiya
- Department of Diagnostic Pathology, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachiojishi, Tokyo, 193-0998, Japan
| | - Hiroshi Hirano
- Department of Diagnostic Pathology, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachiojishi, Tokyo, 193-0998, Japan
| | - Shigeyuki Kawachi
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachiojishi, Tokyo, 193-0998, Japan
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14
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Tamura S, Yamamoto Y, Okamura Y, Sugiura T, Ito T, Ashida R, Ohgi K, Watanabe N, Sasaki K, Sugino T, Uesaka K. A case of duodenal hemorrhage due to arteriovenous malformation around a serous cystic neoplasm. Surg Case Rep 2018; 4:140. [PMID: 30519963 PMCID: PMC6281540 DOI: 10.1186/s40792-018-0547-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/25/2018] [Indexed: 12/25/2022] Open
Abstract
Background No reports have so far described arteriovenous malformation (AVM) in the pancreas caused by a tumor. We herein report a case of pancreatoduodenectomy for a patient who developed duodenal hemorrhage due to AVM developed around serous cystic neoplasm (SCN) of the pancreas. Case presentation A 79-year-old man was referred to our hospital because of anemia (Hb 7.4 g/dl) and pancreatic head tumor. Computed tomography showed microcystic-type SCN, 87 mm in size, in the pancreatic head. Vascular hyperplasia had developed around the cystic lesion. Upper gastrointestinal endoscopy and colonoscopy did not reveal the cause of anemia, so the patient was followed closely without hemostatic therapy. Iron preparations had improved the anemia. Three months later, the patient developed anemia (Hb 5.8 g/dl) again. Gastrointestinal endoscopy showed oozing from the mucosa in the duodenum via the swollen vascular hyperplasia. He was diagnosed as duodenal hemorrhage from the blood vessels around SCN. Pancreatoduodenectomy was performed to control repeated duodenal bleeding. A histopathological examination revealed that the cystic lesion in the pancreatic head was SCN, and the AVM developed around SCN and duodenum, causing repeated duodenal hemorrhage. The patient was discharged on postoperative day 22. Nine months after surgery, the patient had no recurrence of anemia. Conclusions There have been no reports of duodenal hemorrhage due to acquired pancreatic AVM around pancreatic tumor, including SCN. We successfully treated a case of duodenal hemorrhage due to pancreatic AVM around SCN by pancreatoduodenectomy.
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Affiliation(s)
- Shunsuke Tamura
- Department of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 4118777, Japan
| | - Yusuke Yamamoto
- Department of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 4118777, Japan.
| | - Yukiyasu Okamura
- Department of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 4118777, Japan
| | - Teiichi Sugiura
- Department of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 4118777, Japan
| | - Takaaki Ito
- Department of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 4118777, Japan
| | - Ryo Ashida
- Department of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 4118777, Japan
| | - Katsuhisa Ohgi
- Department of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 4118777, Japan
| | - Nobuyuki Watanabe
- Department of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 4118777, Japan
| | - Keiko Sasaki
- Department of Pathology, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 4118777, Japan
| | - Takashi Sugino
- Department of Pathology, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 4118777, Japan
| | - Katsuhiko Uesaka
- Department of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 4118777, Japan
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15
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Healy L, Nicholls K, Gibson R, Stella D, Bogwitz M, Taylor J, Walsh M, Donaldson L, Winship I. Absence of renal phenotype in hereditary haemorrhagic telangiectasia. Intern Med J 2018; 48:1255-1257. [PMID: 30288899 DOI: 10.1111/imj.14059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/21/2018] [Accepted: 04/22/2018] [Indexed: 11/27/2022]
Abstract
Hereditary haemorrhagic telangiectasia is characterised by abnormal blood vessel formation, producing telangiectasia and arteriovenous malformations in multiple organs. Information regarding possible renal involvement in hereditary haemorrhagic telangiectasia is limited. This study assessed renal structure and function in 11 patients with genetically confirmed diagnosis and known arteriovenous malformations in lung, liver, gastrointestinal tract or brain. All had significant current or past epistaxis. Despite the vascularity of the kidneys, we found no evidence of renal involvement. This observation warrants further consideration.
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Affiliation(s)
- Lachlan Healy
- Department of Genomic Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kathleen Nicholls
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Nephrology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Robert Gibson
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Radiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Damien Stella
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Radiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Michael Bogwitz
- Department of Genomic Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jessica Taylor
- Department of Genomic Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Maie Walsh
- Department of Genomic Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Liz Donaldson
- Department of Genomic Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Ingrid Winship
- Department of Genomic Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
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16
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Seike T, Komura T, Shimizu Y, Omura H, Kumai T, Kagaya T, Ohta H, Kawashima A, Harada K, Kaneko S, Unoura M. A case of chronic pancreatitis exacerbation associated with pancreatic arteriovenous malformation: a case report and literature review. Clin J Gastroenterol 2018; 12:135-141. [PMID: 30182162 DOI: 10.1007/s12328-018-0901-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/24/2018] [Indexed: 02/03/2023]
Abstract
A 60-year-old man with an unruptured cerebral aneurysm and family history of moyamoya disease was admitted to our hospital with epigastric pain since the previous day. Serum levels of pancreatic enzyme were elevated and abdominal contrast-enhanced computed tomography showed localized enlargement of the pancreatic tail in the arterial phase and revealed numerous areas of fine mesh-like vascular hyperplasia consistent with an enlarged pancreatic tail. We diagnosed pancreatic arteriovenous malformation (P-AVM) with acute pancreatitis. Furthermore, in the pancreatic body, endoscopic ultrasonography showed lobularity (honeycombing type) and hyperechoic foci (non-shadowing), which suggests chronic pancreatitis. Acute management was performed with conservative treatment including administration of replacement fluids and proteolytic enzyme inhibitor. Distal pancreatectomy for P-AVM was performed because P-AVM is associated with acute pancreatitis recurrence, development of portal hypertension, progression of chronic pancreatitis, and refractory duodenal bleeding. Histological findings on the resected specimens revealed the anastomosis of abnormal arteries and veins, which suggested P-AVM. In addition, inflammation accompanied by fat necrosis due to ischemic infarction in the pancreatic tail, which suggested acute pancreatitis, and mild fibrosis in the pancreatic body, which suggested chronic pancreatitis, were shown. Although P-AVM is associated with various complications, symptomatic P-AVM should be considered a chronic and progressive disease.
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Affiliation(s)
- Takuya Seike
- Department of Gastroenterology, National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan. .,System Biology, Graduate School of Advanced Preventive Medical Science, Kanazawa University, Kanazawa, Japan.
| | - Takuya Komura
- Department of Gastroenterology, National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan
| | - Yoshiaki Shimizu
- Department of Gastroenterology, National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan
| | - Hitoshi Omura
- Department of Gastroenterology, National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan
| | - Tatsuo Kumai
- Department of Gastroenterology, National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan
| | - Takashi Kagaya
- Department of Gastroenterology, National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan
| | - Hajime Ohta
- Department of Gastroenterology, National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan
| | - Atsuhiro Kawashima
- Department of Clinical Laboratory, National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan
| | - Kenichi Harada
- Department of Human Pathology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Shuichi Kaneko
- System Biology, Graduate School of Advanced Preventive Medical Science, Kanazawa University, Kanazawa, Japan
| | - Masashi Unoura
- Department of Gastroenterology, National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan
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17
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A case of pancreatic AV malformation in an elderly man. Clin J Gastroenterol 2018; 11:212-216. [PMID: 29404916 DOI: 10.1007/s12328-018-0825-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 01/29/2018] [Indexed: 10/18/2022]
Abstract
A 60-year-old man presented with recurrent abdominal pain and weight loss for 6 months. Abdominal imaging showed a large vascular lesion in the head and neck of pancreas suggestive of arteriovenous malformation (AV malformation). Endoscopic ultrasound was done which showed features of AV malformation with no evidence of pancreatic malignancy. Surgery was planned for definitive treatment of malformation. Digital subtraction angiography with angioembolization was done prior to surgery to reduce vascularity of the lesion. He recovered after a pylorus preserving pancreaticoduodenectomy. Histopathology of the resected specimen confirmed the pancreatic AV malformation. There has been no recurrence at 2 years of follow-up.
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18
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Choi YI. Distal pancreatectomy for pancreatic arteriovenous malformation: report of a case. Ann Hepatobiliary Pancreat Surg 2017; 21:172-175. [PMID: 28990006 PMCID: PMC5620480 DOI: 10.14701/ahbps.2017.21.3.172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 07/02/2017] [Accepted: 07/07/2017] [Indexed: 01/27/2023] Open
Abstract
Arteriovenous malformation (AVM) of the pancreas is an uncommon disease, which can cause an abdominal pain. This disease is characterized by a tangled vascular network, including the whole or part of the pancreas, resulting in portal hypertension by forming a shunt of the pancreas arteries to drain directly into the portal venous system. This study presents a case that was suspected as AVM of the pancreas by preoperative contrast-enhanced computed tomography scan (CT). A 49-year-old male patient had several episodes of abdominal discomfort associated with dyspepsia for 4 days. Magnetic resonance imaging showed enhancement of the conglomeration about 1.5 cm size in diameter in the pancreas. Selective angiography showed the proliferation of a vascular network in the pancreas and an early visualization of the portal vein during the arterial phase. Distal pancreatectomy with splenectomy was done. Histology of the pancreas showed AVM, with enzymatic fat necrosis extending to the capsule of the pancreas. The patient recovered successfully without postoperative complications. Surgical resection of pancreas is the definitive treatment for symptomatic AVM.
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Affiliation(s)
- Young Il Choi
- Department of Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
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19
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Tanabe H, Takase T, Inaishi T, Masubuchi M, Nomura N, Shibata A, Yaguchi T, Ohnishi E, Okumura N, Koike S, Tagami K. Surgical treatment for rectal cancer with abnormally expanded inferior mesenteric vein resulting from pancreatic arteriovenous malformations. Surg Case Rep 2016; 1:23. [PMID: 26943391 PMCID: PMC4747923 DOI: 10.1186/s40792-015-0021-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 01/20/2015] [Indexed: 12/02/2022] Open
Abstract
A 52-year-old Japanese man presented for evaluation and treatment of rectal cancer. Screening computed tomography revealed pancreatic arteriovenous malformations (P-AVMs) and abnormally expanded inferior mesenteric vein (IMV) that resulted from P-AVMs. One-stage surgery for rectal cancer was dangerous so we first performed distal pancreatectomy to cure P-AVM and thus normalize the abnormally expanded IMV. After the operation, the IMV was occluded by the thrombi, and then the IMV became normal. We could perform safely radical laparoscopic surgery for rectal cancer. This is the first case report of P-AVMs combined with rectal cancer.
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Affiliation(s)
- Hiroshi Tanabe
- Department of Surgery, Atsumi Hospital, 1-1 Akaishi, Kanbe-cho, Tahara, Aichi, 441-3415, Japan.
| | - Tsunenobu Takase
- Department of Surgery, Kainan Hospital, 396 Minamihonden, Maegasu-cho, Yatomi, Aichi, 498-8502, Japan.
| | - Takahiro Inaishi
- Department of Surgery, Kainan Hospital, 396 Minamihonden, Maegasu-cho, Yatomi, Aichi, 498-8502, Japan.
| | - Mariko Masubuchi
- Department of Surgery, Kainan Hospital, 396 Minamihonden, Maegasu-cho, Yatomi, Aichi, 498-8502, Japan.
| | - Naohiro Nomura
- Department of Surgery, Kainan Hospital, 396 Minamihonden, Maegasu-cho, Yatomi, Aichi, 498-8502, Japan.
| | - Arihiro Shibata
- Department of Surgery, Kainan Hospital, 396 Minamihonden, Maegasu-cho, Yatomi, Aichi, 498-8502, Japan.
| | - Toyohisa Yaguchi
- Department of Surgery, Kainan Hospital, 396 Minamihonden, Maegasu-cho, Yatomi, Aichi, 498-8502, Japan.
| | - Eiji Ohnishi
- Department of Surgery, Atsumi Hospital, 1-1 Akaishi, Kanbe-cho, Tahara, Aichi, 441-3415, Japan.
| | - Norio Okumura
- Department of Surgery, Atsumi Hospital, 1-1 Akaishi, Kanbe-cho, Tahara, Aichi, 441-3415, Japan.
| | - Shinya Koike
- Department of Surgery, Atsumi Hospital, 1-1 Akaishi, Kanbe-cho, Tahara, Aichi, 441-3415, Japan.
| | - Kouichirou Tagami
- Department of Surgery, Atsumi Hospital, 1-1 Akaishi, Kanbe-cho, Tahara, Aichi, 441-3415, Japan.
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20
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Abe T, Suzuki N, Haga J, Azami A, Todate Y, Waragai M, Sato A, Takano Y, Kawakura K, Imai S, Sakuma H, Teranishi Y. Arteriovenous malformation of the pancreas: a case report. Surg Case Rep 2016; 2:6. [PMID: 26943682 PMCID: PMC4735097 DOI: 10.1186/s40792-016-0133-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 01/25/2016] [Indexed: 12/18/2022] Open
Abstract
Arteriovenous malformation (AVM) of the pancreas is uncommon in the gastrointestinal tract. We present a case of AVM of the pancreatic head in a 59-year-old male. He was admitted to a hospital with hematemesis and tarry stool and referred to our hospital in March 2014 on the diagnosis of pancreatic artery pseudoaneurysm. A computed tomography scan showed the presence of irregular dilated and/or stenotic vessels with meandering in the pancreatic head. Magnetic resonance imaging showed strong enhancement of the conglomeration in the pancreatic head. Selective angiography showed the proliferation of a vascular network in the pancreatic head and an early visualization of the portal vein at the arterial phase. The patient qualified for surgery with a preoperative diagnosis of AVM of the pancreatic head. We performed pylorus-preserving pancreaticoduodenectomy. The histological results confirmed the presence of irregular dilated tortuous arteries and veins in the pancreatic head. Surgical treatment may represent definitive management of symptomatic AVM.
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Affiliation(s)
- Tsuyoshi Abe
- Department of Surgery, Southern Tohoku Research Institute for Neuroscience, 7-115 Yatsuyamada, Koriyama, 963-8563, Japan.
| | - Nobuyasu Suzuki
- Department of Surgery, Southern Tohoku Research Institute for Neuroscience, 7-115 Yatsuyamada, Koriyama, 963-8563, Japan.
| | - Junichirou Haga
- Department of Surgery, Southern Tohoku Research Institute for Neuroscience, 7-115 Yatsuyamada, Koriyama, 963-8563, Japan.
| | - Ayaka Azami
- Department of Surgery, Southern Tohoku Research Institute for Neuroscience, 7-115 Yatsuyamada, Koriyama, 963-8563, Japan.
| | - Yukitoshi Todate
- Department of Surgery, Southern Tohoku Research Institute for Neuroscience, 7-115 Yatsuyamada, Koriyama, 963-8563, Japan.
| | - Mitsuru Waragai
- Department of Surgery, Southern Tohoku Research Institute for Neuroscience, 7-115 Yatsuyamada, Koriyama, 963-8563, Japan.
| | - Atai Sato
- Department of Surgery, Southern Tohoku Research Institute for Neuroscience, 7-115 Yatsuyamada, Koriyama, 963-8563, Japan.
| | - Yoshinao Takano
- Department of Surgery, Southern Tohoku Research Institute for Neuroscience, 7-115 Yatsuyamada, Koriyama, 963-8563, Japan.
| | - Kenji Kawakura
- Department of Radiology, Southern Tohoku Research Institute for Neuroscience, 7-115 Yatsuyamada, Koriyama, 963-8563, Japan.
| | - Shigeki Imai
- Department of Radiology, Southern Tohoku Research Institute for Neuroscience, 7-115 Yatsuyamada, Koriyama, 963-8563, Japan.
| | - Hideo Sakuma
- Department of Pathology, Southern Tohoku Research Institute for Neuroscience, 7-115 Yatsuyamada, Koriyama, 963-8563, Japan.
| | - Yasushi Teranishi
- Department of Surgery, Southern Tohoku Research Institute for Neuroscience, 7-115 Yatsuyamada, Koriyama, 963-8563, Japan.
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Abstract
Pancreatic arteriovenous malformation is a rare vascular anomaly which may cause abdominal pain, acute pancreatitis, gastrointestinal bleeding and portal hypertension. Pancreatic arteriovenous malformation is mostly congenital; however secondary pancreatic arteriovenous malformation due to pancreatitis has been suggested by some authors. We encountered a case which can confirm this presumption. Several imaging modalities are useful for the diagnosis of pancreatic arteriovenous malformation, especially dynamic contrast-enhanced studies. Angiography is the most important diagnostic tool because of the dynamic features of this vascular lesion. Treatment is advised and consists of surgical resection and/or transarterial embolization.
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Fukami Y, Kurumiya Y, Mizuno K, Sekoguchi E, Kobayashi S. Pancreatic arteriovenous malformation with portal vein thrombosis. Surgery 2015; 157:171-2. [PMID: 25625157 DOI: 10.1016/j.surg.2013.06.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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23
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Hansen W, Maximin S, Shriki JE, Bhargava P. Multimodality imaging of pancreatic arteriovenous malformation. Curr Probl Diagn Radiol 2014; 44:105-9. [PMID: 25262988 DOI: 10.1067/j.cpradiol.2014.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 08/10/2014] [Indexed: 11/22/2022]
Abstract
Arteriovenous malformation of the pancreas (PAVM) is a very rare entity, although it may be increasingly diagnosed with the expanding use of cross-sectional imaging of the abdomen. PAVM is characterized by a network of tangled vasculature within and surrounding all or part of the pancreas, resulting in the shunting of the arteries of the pancreas directly into the portal venous system. Here, we present a patient with chronic abdominal pain and pancreatitis found to have PAVM, based on the findings of computed tomography, magnetic resonance imaging, endoscopic retrograde cholangiopancreatography, and angiography. Differential considerations are discussed. Although PAVM is uncommon, it should be considered in the differential of patients with recurrent abdominal pain or gastrointestinal bleeding.
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Affiliation(s)
- Wendy Hansen
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - Suresh Maximin
- Department of Radiology, University of Washington School of Medicine, Seattle, WA; Puget Sound VA Healthcare System, Seattle, WA
| | - Jabi E Shriki
- Department of Radiology, University of Washington School of Medicine, Seattle, WA; Puget Sound VA Healthcare System, Seattle, WA.
| | - Puneet Bhargava
- Department of Radiology, University of Washington School of Medicine, Seattle, WA; Puget Sound VA Healthcare System, Seattle, WA
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24
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Jana T, Machicado JD, Guha S. Gastrointestinal bleeding caused by pancreatic arteriovenous malformation. Clin Gastroenterol Hepatol 2014; 12:A29-A30. [PMID: 24530599 DOI: 10.1016/j.cgh.2014.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 02/03/2014] [Indexed: 02/07/2023]
Affiliation(s)
- Tanima Jana
- Department of Internal Medicine, University of Texas Medical School at Houston, Houston, Texas
| | - Jorge D Machicado
- Department of Internal Medicine, University of Texas Medical School at Houston, Houston, Texas
| | - Sushovan Guha
- Division of Gastroenterology, Hepatology and Nutrition, University of Texas Medical School at Houston, Houston, Texas
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25
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Yamabuki T, Ohara M, Kimura N, Okamura K, Kuroda A, Takahashi R, Komuro K, Iwashiro N. Pancreatic arteriovenous malformation. Case Rep Gastroenterol 2014; 8:26-31. [PMID: 24574946 PMCID: PMC3934809 DOI: 10.1159/000358193] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
An unusual case of pancreatic arteriovenous malformation (P-AVM) combined with esophageal cancer is reported. A 59-year-old man was admitted with upper abdominal pain. Contrast-enhanced computed tomography showed numerous strongly enhanced abnormal vessels and a hypovascular lesion in the area of the pancreatic tail. Angiographic study of the celiac artery confirmed racemose vascular networks in the tail of the pancreas. Endoscopic retrograde pancreatography revealed narrowing and displacement of the main pancreatic duct in the tail of the pancreas. Screening esophagoscopy showed a 0-IIa+IIc type tumor in the lower thoracic esophagus. Histological examination of esophagoscopic biopsies showed squamous cell carcinoma. Based on these findings, P-AVM or pancreatic cancer and esophageal cancer were diagnosed. Video-assisted thoracoscopic esophagectomy and distal pancreatectomy were performed. Histological examination of the resected pancreas revealed abundant abnormal vessels with intravascular thrombi. In addition, rupture of a dilated pancreatic duct with pancreatic stones and both severe atrophy and fibrosis of the pancreatic parenchyma were observed. The final diagnoses were P-AVM consequent to severe chronic pancreatitis and esophageal carcinoma. The patient's postoperative course was relatively good.
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Affiliation(s)
- Takumi Yamabuki
- Department of Surgery, National Hospital Organization Hakodate Hospital, Hakodate, Japan
| | - Masanori Ohara
- Department of Surgery, National Hospital Organization Hakodate Hospital, Hakodate, Japan
| | - Noriko Kimura
- Pathology, National Hospital Organization Hakodate Hospital, Hakodate, Japan
| | - Kunishige Okamura
- Department of Surgery, National Hospital Organization Hakodate Hospital, Hakodate, Japan
| | - Aki Kuroda
- Department of Surgery, National Hospital Organization Hakodate Hospital, Hakodate, Japan
| | - Ryo Takahashi
- Department of Surgery, National Hospital Organization Hakodate Hospital, Hakodate, Japan
| | - Kazuteru Komuro
- Department of Surgery, National Hospital Organization Hakodate Hospital, Hakodate, Japan
| | - Nozomu Iwashiro
- Department of Surgery, National Hospital Organization Hakodate Hospital, Hakodate, Japan
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26
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Tatsuta T, Endo T, Watanabe K, Hasui K, Sawada N, Igarashi G, Mikami K, Shibutani K, Tsushima F, Takai Y, Fukuda S. A successful case of transcatheter arterial embolization with n-butyl-2-cyanoacrylate for pancreatic arteriovenous malformation. Intern Med 2014; 53:2683-7. [PMID: 25447650 DOI: 10.2169/internalmedicine.53.3327] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
A 57-year-old man was referred and admitted to our hospital for treatment of a symptomatic pancreatic mass. Pancreatic arteriovenous malformation (AVM) was diagnosed based on the findings of contrast-enhanced computed tomography (CT) and angiography, and transcatheter arterial embolization (TAE) with N-butyl-2-cyanoacrylate (NBCA) was performed without complications. The patient's symptoms subsequently improved after TAE, and resolution of the pancreatic AVM was detected on contrast-enhanced CT performed six months after the embolization procedure. This case indicates that TAE with NBCA is a safe and effective treatment for pancreatic AVM.
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Affiliation(s)
- Tetsuya Tatsuta
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Japan
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27
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Clinical experiences in the treatment of pancreatic arteriovenous malformation by total pancreatectomy with islet autotransplantation. Transplantation 2013; 96:e38-40. [PMID: 23995868 DOI: 10.1097/tp.0b013e3182a01333] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Chou SC, Shyr YM, Wang SE. Pancreatic arteriovenous malformation. J Gastrointest Surg 2013; 17:1240-6. [PMID: 23636883 DOI: 10.1007/s11605-013-2217-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 04/23/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pancreatic arteriovenous malformation is very rare, but may cause significant clinical symptoms such as catastrophic bleeding. Herein, we discuss the clinical presentation and management of patients pancreatic arteriovenous malformations. METHODS The data pool for the analysis was collected from pancreatic arteriovenous malformation cases encountered by our institution and sporadic case reports in the English literature. RESULTS A total of 89 cases of pancreatic arteriovenous malformation were collected for this study, including 59 cases of arteriovenous malformation in the pancreatic head (62.3 %) and 30 in the pancreatic body-tail (33.7 %). The most commonly associated complications for overall cases of pancreatic arteriovenous malformation were bleeding (50.6 %), pancreatitis (16.9 %), portal hypertension (6.7 %), and pseudocyst (3.4 %). The most common presenting symptom of pancreatic arteriovenous malformation was gastrointestinal bleeding (47.2 %), followed by epigastric pain (46.1 %). Surgery (43.8 %) was the most common treatment for pancreatic arteriovenous malformation cases, followed by transarterial embolization (11.2 %), a combination of surgery and transarterial embolization (10.1 %), and radiotherapy (2.2 %). No intervention was done for 29.2 % of the cases of pancreatic arteriovenous malformation. CONCLUSIONS Pancreatic arteriovenous malformation occurs most commonly in the pancreatic head; gastrointestinal bleeding is the main symptom. Surgical resection or transarterial embolization appears to be indicated in patients with symptomatic pancreatic arteriovenous malformation.
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Affiliation(s)
- Shu-Cheng Chou
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang Ming University, 10 F 201 Section 2 Shipai Road, Taipei, 112, Taiwan
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29
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Makhoul F, Kaur P, Johnston TD, Jeon H, Gedaly R, Ranjan D. Arteriovenous malformation of the pancreas: A case report and review of literature. Int J Angiol 2012; 17:211-3. [PMID: 22477452 DOI: 10.1055/s-0031-1278312] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Extrahepatic arteriovenous malformations (AVMs) of the gastrointestinal (GI) tract are rare and mostly asymptomatic congenital anomalies. The present case describes a 45-year-old woman with an AVM in the head of the pancreas, which caused massive GI bleeding that recurred after embolization, and which was subsequently treated with a pylorus-preserving Whipple pancreaticoduodenectomy. The authors then review the available literature pertaining to AVMs of the GI tract, the diagnostic modalities that have been used to identify them and the treatment approaches that have been described to date, which range from coil embolization of the feeding artery to radical resection of the affected organ. It is important to remember that these lesions shunt blood between the high-pressure arterial system and the low-pressure portal system, which leads to the much-dreaded consequence of portal hypertension.
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Affiliation(s)
- Fadi Makhoul
- General Surgery, University of Kentucky, Lexington, Kentucky, USA
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30
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Song KB, Kim SC, Park JB, Kim YH, Jung YS, Kim MH, Lee SK, Lee SS, Seo DW, Park DH, Kim JH, Han DJ. Surgical outcomes of pancreatic arteriovenous malformation in a single center and review of literature. Pancreas 2012; 41:388-396. [PMID: 22129532 DOI: 10.1097/mpa.0b013e31822a25cc] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Pancreatic arteriovenous malformation (P-AVM) is an extremely rare condition that can be accompanied by fatal complications. We have attempted to identify the possible management guidelines based on our and others' clinical experience. METHODS We retrospectively analyzed our findings including clinical characteristics, imaging modalities, and treatment in 12 patients. Sporadic reports of 69 patients with P-AVM were surveyed for representative characteristics and treatment strategy. RESULTS The mean age at diagnosis was 49.8 years (range, 44-64 years), and all 12 were male. The mean body mass index was 21.5 kg/m (range, 18.3-24.3 kg/m) and 6 (50%) were heavy smokers (mean, 30.9 pack-years; range, 7.5-120 pack-years). The most common clinical symptom is gastrointestinal bleeding, followed by abdominal pain. All patients were diagnosed with abdominal disease using computed tomography. Of the 12 patients, 11 underwent pancreatic resection and 1 patient was managed conservatively. No patient experienced any major postoperative complications during the median follow-up of 37 months. CONCLUSIONS In patients with symptomatic P-AVM, surgical resection of the affected pancreas showed a successful result. When a patient is at a high risk for surgical treatment, transjugular intrahepatic portosystemic shunt, transarterial embolization, and radiation therapy might be other treatment options.
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Affiliation(s)
- Ki Byung Song
- Department of Surgery, Ulsan University College of Medicine, Asan Medical Center, Seoul, South Korea
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31
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Pancreatic arteriovenous malformation involving the duodenum embolized with ethylene-vinyl alcohol copolymer (Onyx). Cardiovasc Intervent Radiol 2011; 35:958-62. [PMID: 21953209 DOI: 10.1007/s00270-011-0272-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 08/23/2011] [Indexed: 12/22/2022]
Abstract
Arteriovenous malformation (AVM) of the pancreas is a rare condition. Most patients are asymptomatic or alternatively may present with a wide spectrum of symptoms. Traditionally, surgery has been considered the treatment of choice; however, alternative approaches, such as transcatheter embolization (TAE), may be proposed. We report a case of a 48-year-old man with a pancreatic head AVM, presenting with upper abdominal pain and slight anemia. The patient refused surgery and underwent TAE by means of ethylene-vinyl alcohol copolymer (EVOH). At 3 months follow-up, the patient was able to eat regularly, with no residual pain and no signs of anemia.
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32
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Park SY, Yoon KW, Park CH, Seo TJ, Chung HK, Rew HS, Cho SB, Lee WS, Kim HS, Choi SK, Rew JS. A case of recurrent infection caused by a pancreaticoduodenal fistula associated with a pancreatic arteriovenous malformation. Gut Liver 2011; 5:391-4. [PMID: 21927673 PMCID: PMC3166685 DOI: 10.5009/gnl.2011.5.3.391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Accepted: 06/22/2010] [Indexed: 11/17/2022] Open
Abstract
Although arteriovenous malformations (AVM) occur frequently in digestive organs, pancreatic AVM is rare. The clinical symptoms of pancreatic AVM are variable and include gastrointestinal bleeding, abdominal pain, jaundice, portal hypertension, pancreatitis, and duodenal ulcer. However, choledochoduodenal or pancreaticoduodenal fistulas complicated with ascending infection and pancreatitis is extremely rare. Herein, we report a case of pancreaticoduodenal fistula associated with a pancreatic AVM that induced recurrent anemia and ascending infection.
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Affiliation(s)
- Seon-Young Park
- Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
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Sharma M, Bedi MMS, Mahesh S, Gandhi MD, Antony R, Mukkada RJ, Lekha V, Ramesh H. Arteriovenous malformation of the pancreatic head--difficulties in diagnosis and treatment. Indian J Gastroenterol 2011; 30:46-8. [PMID: 21286888 DOI: 10.1007/s12664-010-0070-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Accepted: 12/03/2010] [Indexed: 02/04/2023]
Abstract
A patient with pancreatic arteriovenous malformation who presented diagnostic and therapeutic difficulties is presented. The initial tests appeared to suggest inflammatory bowel disease, but the diagnosis was clinched by the finding of blood issuing from the ampulla of Vater. Repeated angiographic embolization did not obliterate the vascular malformation, and the symptoms eventually resolved after Whipple's pancreaticoduodenectomy.
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Affiliation(s)
- M Sharma
- Department of Surgical Gastroenterology and Radiology, Lakeshore Hospital and Research Center, Cochin, Kerala, India
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34
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Choi JK, Lee SH, Kwak MS, Kim JH, Jang ES, Hwang SW, Hwang JH, Joo LJ, Yoon YS, Kim HR. A Case of Recurrent Acute Pancreatitis due to Pancreatic Arteriovenous Malformation. Gut Liver 2010; 4:135-9. [PMID: 20479928 DOI: 10.5009/gnl.2010.4.1.135] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2009] [Accepted: 08/11/2009] [Indexed: 11/04/2022] Open
Abstract
Pancreatic arteriovenous malformation (AVM) is an extremely rare condition with various clinical manifestations. We report herein a case of recurrent acute pancreatitis due to pancreatic AVM in a 49-year-old man. This patient presented with epigastric pain that had developed after consuming alcohol 2 days prior to admission. Serum amylase and lipase levels were elevated and computed tomography revealed focal low-attenuation lesions with peripancreatic infiltrations in the pancreatic tail and multiple collateral vessels around the low-attenuation lesions. He was diagnosed with acute pancreatitis and pancreatic AVM. Although he had stopped drinking after the first attack of acute pancreatitis, his pancreatitis recurred twice within 3 months. He underwent a distal pancreatectomy after the third attack of acute pancreatitis. He was free of symptoms for 2 years after the pancreatectomy.
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Affiliation(s)
- Jong Kyoung Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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35
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Abstract
Pancreatic arteriovenous malformation (AVM) is a rare disease, generally asymptomatic, but sometimes complicated by gastrointestinal bleeding or pancreatitis. We report a case of a 55-year-old man presenting with a large pancreatic AVM. The diagnosis was obtained on a computed tomography scan. A treatment by transarterial embolization was carried out successfully. Selective arterial embolization of pancreatic AVM can represent an effective treatment in the first intention.
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36
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Ogawa H, Itoh S, Mori Y, Suzuki K, Ota T, Naganawa S. Arteriovenous malformation of the pancreas: assessment of clinical and multislice CT features. ACTA ACUST UNITED AC 2008; 34:743-52. [DOI: 10.1007/s00261-008-9465-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Accepted: 09/26/2008] [Indexed: 12/26/2022]
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37
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Miyabe K, Akita S, Kitajima Y, Hirai M, Naitoh I, Hayashi K, Okamoto T, Okayama Y, Gotoh K, Ohara H, Joh T, Yokoyama Y, Itoh M. Rupture of hepatic aneurysm complicating hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease) for which hepatic arterial coil embolization was effective. J Gastroenterol Hepatol 2007; 22:2352-7. [PMID: 18031399 DOI: 10.1111/j.1440-1746.2006.03456.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
A 74-year-old woman was transferred to our hospital for further examinations because of abdominal fullness and abnormal levels of serum liver/biliary enzyme persisting for 3 weeks. She had anemia and dilatation of many capillary vessels in her fingers, palms, and tongue in addition to reporting frequent incidences of nasal bleeding in herself and her family. Abdominal ultrasonography detected a cystic lesion in the right hepatic lobe, connected to a dilated tortuous hepatic artery. A low-echoic hepatic phyma was also detected in the back of the cystic lesion. Abdominal computed tomography and magnetic resonance imaging indicated that the cystic lesion was an aneurysm and the low-echoic phyma was a hematoma. Hepatic arteriography confirmed a hepatic aneurysm, tortuous dilatation of the hepatic artery, and the complication of an arteriovenous shunt in the liver. Taking all of these findings into consideration, this case was diagnosed as hereditary hemorrhagic telangiectasia (HTT) complicated by a hepatic aneurysm causing intrahepatic hematoma. To prevent re-rupture of the aneurysm, we performed a hepatic arterial coil embolization. After therapy, no blood flow to the aneurysm was detected by ultrasonic color Doppler method and the hematoma gradually diminished. There have been no reports of a case in which hepatic arterial embolization was effective for HHT-associated hepatic aneurysm causing intrahepatic hematoma. This very rare case provides important clinical information regarding abdominal vascular complications of HTT and a less invasive treatment for them.
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Affiliation(s)
- Katsuyuki Miyabe
- Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan.
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38
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Butte JM, San Francisco IF, Pacheco F, Solar A, Crovari FJ, Jarufe NP. Arteriovenous malformation of the pancreas: report of a case. Surg Today 2007; 37:604-7. [PMID: 17593483 DOI: 10.1007/s00595-006-3459-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2006] [Accepted: 11/19/2006] [Indexed: 11/28/2022]
Abstract
Arteriovenous malformation (AVM) of the pancreas (AVMP) is uncommon and generally asymptomatic; therefore, few cases have so far been reported. The symptoms of AVMP include gastrointestinal bleeding, pain, and portal hypertension. Definitive diagnosis is confirmed by angiographic study, and surgery is the only effective treatment. We report a case of AVMP confirmed by computed tomography, magnetic resonance imaging, and angiographic study of the abdomen, in a patient who presented to us with epigastric pain. He underwent a pancreaticoduodenectomy, following which his symptoms resolved.
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Affiliation(s)
- Jean M Butte
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 367, Santiago, Chile
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39
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Tulachan SS, Tei E, Hembree M, Crisera C, Prasadan K, Koizumi M, Shah S, Guo P, Bottinger E, Gittes GK. TGF-beta isoform signaling regulates secondary transition and mesenchymal-induced endocrine development in the embryonic mouse pancreas. Dev Biol 2007; 305:508-21. [PMID: 17418116 PMCID: PMC1968155 DOI: 10.1016/j.ydbio.2007.02.033] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2006] [Revised: 02/21/2007] [Accepted: 02/26/2007] [Indexed: 02/05/2023]
Abstract
Transforming growth factor-beta (TGF-beta) superfamily signaling has been implicated in many developmental processes, including pancreatic development. Previous studies are conflicting with regard to an exact role for TGF-beta signaling in various aspects of pancreatic organogenesis. Here we have investigated the role of TGF-beta isoform signaling in embryonic pancreas differentiation and lineage selection. The TGF-beta isoform receptors (RI, RII and ALK1) were localized mainly to both the pancreatic epithelium and mesenchyme at early stages of development, but then with increasing age localized to the pancreatic islets and ducts. To determine the specific role of TGF-beta isoforms, we functionally inactivated TGF-beta signaling at different points in the signaling cascade. Disruption of TGF-beta signaling at the receptor level using mice overexpressing the dominant-negative TGF-beta type II receptor showed an increase in endocrine precursors and proliferating endocrine cells, with an abnormal accumulation of endocrine cells around the developing ducts of mid-late stage embryonic pancreas. This pattern suggested that TGF-beta isoform signaling may suppress the origination of secondary transition endocrine cells from the ducts. Secondly, TGF-beta isoform ligand inhibition with neutralizing antibody in pancreatic organ culture also led to an increase in the number of endocrine-positive cells. Thirdly, hybrid mix-and-match in vitro recombinations of transgenic pancreatic mesenchyme and wild-type epithelium also led to increased endocrine cell differentiation, but with different patterns depending on the directionality of the epithelial-mesenchymal signaling. Together these results suggest that TGF-beta signaling is important for restraining the growth and differentiation of pancreatic epithelial cells, particularly away from the endocrine lineage. Inhibition of TGF-beta signaling in the embryonic period may thus allow pancreatic epithelial cells to progress towards the endocrine lineage unchecked, particularly as part of the secondary transition of pancreatic endocrine cell development. TGF-beta RII in the ducts and islets may normally serve to downregulate the production of beta cells from embryonic ducts.
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Affiliation(s)
- Sidhartha S. Tulachan
- Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Eri Tei
- Laboratory of Surgical Organogenesis, Children’s Mercy Hospital, Kansas City, MO
| | - Mark Hembree
- Laboratory of Surgical Organogenesis, Children’s Mercy Hospital, Kansas City, MO
| | - Christopher Crisera
- University of California at Los Angeles, School of Medicine, Los Angeles, CA
| | - Krishna Prasadan
- Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Masayuki Koizumi
- Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Sohail Shah
- Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Ping Guo
- Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - George K Gittes
- Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA
- * Corresponding author: George K. Gittes, M.D., Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, 3705, Fifth Avenue, Pittsburgh, PA 15213-2583, Phone: (412) 692-7291, Fax: (412) 692-5008,
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Takemoto I, Tsuda M, Yano Y, Miyazaki H, Yamada H, Azuma T, Maeda S, Nakajima T, Kasuga M. Pancreatic arteriovenous malformation combined with portal thrombosis. Intern Med 2007; 46:233-6. [PMID: 17329918 DOI: 10.2169/internalmedicine.46.1852] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We encountered a case of portal vein thrombosis (PVT) after treatment for portal hypertension due to pancreatic arteriovenous malformation (PAVM). A 75-year-old man was admitted for the treatment of esophageal varices. Diffuse PAVM and aneurysm in the celiac and superior mesenteric arteries were detected via abdominal computed tomography and angiography. Although endoscopical sclerotherapy was performed, PVT was identified after the treatment and variceal bleeding continued. Autopsy was performed and the thrombus and malformation were pathologically confirmed. This case indicates that PVT can be associated with PAVM.
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Affiliation(s)
- Ikuyo Takemoto
- Department of Clinical Molecular Medicine, Division of Diabetes, Digestive and Kidney Diseases, Kobe, Japan
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41
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Hosogi H, Ikai I, Hatano E, Taura K, Fujii H, Yamamoto Y, Shimahara Y. Pancreatic arteriovenous malformation with portal hypertension. ACTA ACUST UNITED AC 2006; 13:344-6. [PMID: 16858547 DOI: 10.1007/s00534-005-1068-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2005] [Accepted: 10/25/2005] [Indexed: 12/01/2022]
Abstract
A 45-year-old man with recurrent episodes of hematemesis caused by extensive varices in the esophagus and stomach was admitted. He had a history of liver cirrhosis with hepatitis C virus infection. Computed tomography revealed a conglomeration of small strong nodular stains in the pancreatic head. Angiography revealed a racemose vascular network at the same site and early appearance of the portal venous system in the arterial phase. With a diagnosis of pancreatic arteriovenous malformation with portal hypertension, he underwent pylorus-preserving pancreaticoduodenectomy, preceded, 2 days earlier, by transcatheter arterial embolization of some of the feeding arteries. The varices observed preoperatively in the esophagus and stomach disappeared, and he has been well for 6 years after the operation. We reviewed 47 cases of pancreatic arteriovenous malformation previously reported in the English-language literature, with a focus on the clinical manifestations, treatment approaches, and etiological relationship with portal hypertension and liver cirrhosis.
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Affiliation(s)
- Hisahiro Hosogi
- Department of Gastroenterological Surgery, Kyoto University Graduate School of Medicine, Shogoin, Kyoto 606-8507, Japan
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42
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Uchida E, Aimoto T, Nakamura Y, Katsuno A, Chou K, Kawamoto M, Ono S, Ishii N, Miyake K, Fujimori S, Sakamoto C, Tajiri T. Pancreatic Arteriovenous Malformation Involving Adjacent Duodenum with Gastrointestinal Bleeding: Report of a Case. J NIPPON MED SCH 2006; 73:346-50. [PMID: 17220587 DOI: 10.1272/jnms.73.346] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A 54-year-old man was admitted to our hospital with the symptoms of palpitation, dyspnea, and tarry stool. Upper gastroduodenal endoscopy revealed submucosal lesions with vascular ectasia in the second part of the duodenum. Dynamic computed tomography (CT) detected a hypervascular lesion in the pancreatic head and the duodenum. Selective angiography showed proliferation of a vascular network and early filling of the portal vein at the early arterial phase. With a diagnosis of pancreatic arteriovenous malformation (AVM), we performed pylorus-preserving pancreaticoduodenectomy. At laparotomy, localized and meandering vessels were seen on the surface of the head of the pancreas. Histological examination showed dilated tortuous vessels accompanied by severed elastic fibers in the vessel media and blood clot formation. The incidence of pancreatic AVM remains extremely low, and recurrent gastrointestinal bleeding is a frequent complication. To prevent recurrent bleeding and progressive portal hypertension, surgery may be the definitive management of symptomatic AVM.
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Affiliation(s)
- Eiji Uchida
- Surgery for Organ Function and Biological Regulation, Nippon Medical School Graduate School of Medicine, Tokyo, Japan.
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43
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Abstract
Hereditary hemorrhagic telangiectasia (HHT), also known as Osler-Weber-Rendu disease, is an hereditary disorder that results in fibrovascular dysplasia with the development of telangiectasias and arteriovenous malformations. It predominantly involves the skin, mucous membranes, viscera, lungs, and brain. Hereditary hemorrhagic telangiectasia shows great genetic heterogeneity, and its phenotypes have been classified based on the recently identified mutated genes: endoglin (HHT-1) and activin-like kinase receptor-1 (HHT-2). Other families with phenotypic HHT do not bear these mutations; therefore, other genes are probably involved as well. Liver involvement is reported in up to 30% of persons affected by HHT. Large arteriovenous malformations in the liver can lead to significant complications, including high-output congestive heart failure, portal hypertension, hepatic encephalopathy, biliary ischemia, and liver failure. Embolization of large arteriovenous malformations in the liver remains controversial; however, liver transplantation can successfully eradicate these complications.
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Affiliation(s)
- Anne M Larson
- Department of Medicine, University of Washington, Seattle, 98195-6174, USA.
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44
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Mizuno K, Itoh K, Monoe T, Itoh Y, Matsui T, Kondo Y, Wada T, Kanai M, Ohara H, Itoh M. Pancreaticobiliary arteriovenous malformation with common bile duct dilation in a patient with hemobilia. J Clin Gastroenterol 2001; 33:61-3. [PMID: 11418794 DOI: 10.1097/00004836-200107000-00015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Arteriovenous malformation of the pancreas is a very rare entity. We describe a case involving the head of the pancreas associated with progressive hemobilia bleeding from the lower part of the common bile duct. The patient was a 50-year-old man with acute epigastralgia. Endoscopic retrograde cholangiopancreatography revealed hemobilia and cystic dilation of the common bile duct. Angiography demonstrated increased blood volume in the head of the pancreas and early filling of the superior mesenteric and portal veins. Abdominal pain and progressive anemia caused by hemobilia required surgical treatment. Histologic examination of the resected specimen revealed marked proliferation of the blood vessels in the pericholedochal area and the exact point of bleeding from the pancreaticobiliary arteriovenous malformation.
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Affiliation(s)
- K Mizuno
- Department of Gastroenterology, Kasugai Municipal Hospital, 1-1-1 Takagi-cho, Kasugai, Aichi, 486-8520, Japan.
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45
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Koito K, Namieno T, Nagakawa T, Ichimura T, Hirokawa N, Mukaiya M, Hirata K, Hareyama M. Congenital arteriovenous malformation of the pancreas: its diagnostic features on images. Pancreas 2001; 22:267-73. [PMID: 11291928 DOI: 10.1097/00006676-200104000-00007] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
To analyze diagnostic features on images of congenital arteriovenous malformation (AVM) of the pancreas, we analyzed the diagnostic findings in six patients with the disease, using gray-scale ultrasonography (US), color Doppler US, computed tomography, and angiography and analyzed previously reported cases. AVM characteristic findings on images were multiple, small hypoechoic nodules on US, mosaic appearance of the lesion and pulsatile wave form in the portal vein on color Doppler US, conglomerated small nodular enhancement of the lesion and early appearance of the portal vein on CT, and a racemose network and early appearance of the portal vein on angiography. Five of the six patients underwent surgery, and all resected specimens were histologically found to be AVMs of the pancreas; however, one with developed portal hypertension at surgery died of repeated bleeding from esophageal varices. From analysis of total of 35 cases including our six cases, a mosaic appearance of the lesion was found in 100% and a pulsatile wave form in the portal vein in 77.8% on color Doppler US. Color Doppler US is noninvasive and useful for detecting congenital AVM of the pancreas at an early stage, preventing the portal hypertension causing esophageal varices and their rupture.
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Affiliation(s)
- K Koito
- Department of Radiology, Sapporo Medical University, Japan.
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46
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Notoya A, Bohgaki T, Mukai M, Kohno M, Sato H, Sawada K. Splenomegaly and chronic disseminated intravascular coagulation in Osler-Weber-Rendu disease: a case report. Am J Hematol 2000; 65:315-8. [PMID: 11074562 DOI: 10.1002/1096-8652(200012)65:4<315::aid-ajh12>3.0.co;2-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A 45-year-old Japanese woman with splenomegaly and thrombocytopenia was referred to our hospital. The diagnosis of Osler-Weber-Rendu disease (Osler's disease) was made because of spotty telangiectasia on her tongue, recurrent epistaxis since childhood, and a diathesis indicated by her family history. The patient's laboratory examination revealed anemia, thrombocytopenia, and other data consistent with chronic disseminated intravascular coagulation (DIC). Bone marrow examination was normal. Abdominal computed tomography showed marked enlargement of the spleen with deformity and calcified plaque, not homogeneously enhancing. Hypersplenism was not observed. Platelet scintigraphy indicated a remarkable uptake in the spleen. She was diagnosed as having chronic DIC associated with vascular lesions of Osler's disease in the spleen. Splenectomy was performed and the subsequent pathological findings indicated that fragility of the fine vascular architecture of the splenic red pulp might have been responsible for pathogenesis. The large pooling of blood with coagulation was thought to be secondary.
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Affiliation(s)
- A Notoya
- Department of Clinical Immunology and Hematology, Sapporo City General Hospital, Sapporo, Hokkaido, Japan
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47
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Abstract
Both hereditary hemorrhagic telangiectasia (HHT) and portal vein aneurysm are rare disorders. We described the first documented case of HHT associated with portal vein aneurysm. As the portal vein aneurysm in this patient associated with HHT, the pathogenesis in this patient seems to have been a congenital anomaly of the vasculature.
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Affiliation(s)
- O Sezgin
- Gastroenterology Clinic of Türkiye Yüksek Ihtisas Hospital, Ankara, Turkey
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48
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Shovlin CL, Letarte M. Hereditary haemorrhagic telangiectasia and pulmonary arteriovenous malformations: issues in clinical management and review of pathogenic mechanisms. Thorax 1999; 54:714-29. [PMID: 10413726 PMCID: PMC1745557 DOI: 10.1136/thx.54.8.714] [Citation(s) in RCA: 280] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- C L Shovlin
- Respiratory Medicine, Imperial College School of Medicine, National Heart and Lung Institute, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
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49
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Uda O, Aoki T, Tsuchida A, Asami K, Inoue K, Masuhara S, Koyanagi Y, Hakamada Y, Yasuda D. Pancreatic arteriovenous malformation observed to bleed from the bile duct and a duodenal ulcer: report of a case. Surg Today 1999; 29:462-6. [PMID: 10333421 DOI: 10.1007/bf02483042] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 48-year-old man with recurrent episodes of biliary colic and subsequent pancreatitis was admitted to undergo a cholecystectomy. A gastroduodenal fiberscopic examination was performed because of massive melena on the seventh day after admission. It revealed a shallow ulcer on the posterior wall of a duodenal bulbus with rubor and an exposed vessel, which was clipped endoscopically to stop the bleeding. Further observations showed the papilla of Vater to be bleeding from the papilla. A contrast-enhanced abdominal computed tomography scan demonstrated a dilatation of the common bile duct and several dilated vasculatures around the portal vein, some of which drained into the portal vein. Based on the angiography findings, a diagnosis of arteriovenous malformation in the pancreas head was obtained and an embolization of the gastroduodenal artery was performed. Although the melena subsided, he underwent a pylorus-preserving pancreatoduodenectomy to prevent the recurrence of hemorrhaging. The histopathological findings of the bile duct revealed inflammatory cell infiltration and a detachment of the epithelium, except in a small part of the bile duct. A rupture of a damaged vessel inside the bile duct was observed, which was thought to be the cause of hemobilia. Sections of the pancreatic head demonstrated an inflammatory lesion with fibrosis and saponification as well as a large degree of arteriovenous anastomosis. The patient was discharged on the 35th day after the operation following an uneventful postoperative course.
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Affiliation(s)
- O Uda
- Department of Surgery, Tokyo Medical College, Japan
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50
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Hayashi N, Sakai T, Kitagawa M, Inagaki R, Yamamoto T, Ishii Y, Maehara M, Nakagawara G. Intractable gastrointestinal bleeding caused by pancreatic arteriovenous malformation: successful treatment with transjugular intrahepatic portosystemic shunt. Eur J Radiol 1998; 28:164-6. [PMID: 9788023 DOI: 10.1016/s0720-048x(97)00135-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- N Hayashi
- Department of Radiology, Fukui Medical School, Japan.
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