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.
Highlights
An arteriovenous malformation (AVM) is a complex tangle of abnormal arteries and veins linked by one or more direct connections called a fistula or shunt
The number of reported cases of AVM in digestive organs has increased in recent years because of the widespread use of imaging modalities such as angiography, computed tomography (CT), magnetic resonance imaging, and color Doppler ultrasonography
Congenital AVMs are caused by the abnormal development of the arteriovenous plexus in the embryo, whereas acquired AVMs are caused by pancreatitis, tumors, or trauma
Summary
An arteriovenous malformation (AVM) is a complex tangle of abnormal arteries and veins linked by one or more direct connections called a fistula or shunt. Case presentation A 59-year-old male was admitted to another hospital in March 2014 with symptoms of hematemesis and tarry stool. He had a history of hypertension, cardiac infarction, and aortic regurgitation. A CT scan showed the presence of meandering irregular dilated vessels in the pancreatic head (Fig. 1a) and an early appearance of the portal vein at the arterial phase (Fig. 1b). Further evaluation using 3D imaging showed feeder vessels from the superior mesenteric, celiac, and splenic arteries (Fig. 1c). Magnetic resonance imaging showed the strong enhancement of the conglomeration in the pancreatic head (Fig. 2a), and reformed maximum intensity projection imaging showed feeder vessels from the superior mesenteric and celiac arteries with an early appearance of the portal vein at the arterial phase (Fig. 2b). He remains a healthy and disease-free 19 months after surgery
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