A Case of Arteriovenous Malformation (AVM) of the Pancreas Head

Shuji Suzuki, Fujio Hanyu, Seiichi Tanaka, Tomoyuki Imazato, Yasuyoshi Takeo, Honami Teramoto, Tomoyuki Koga, Tsuneo Hayashi, Ken Takasaki*

Hachioji Digestive Disease Hospital
*Institute of Gastroenterology, Tokyo Women's Medical College

Pancreatic arteriovenous malformation (AVM) is a very rare disease. A case of pancreatic AVM which could be treated by surgical resection is reported. A 49-year-old man was referred with epigastralgia and increasing back pain. Abdominal ultrasound examination revealed a low echoic lesion in the head of the pancreas with rapid blood flow dopplar signals. Stenosis of the distal end of the common bile duct and bleeding through the orifice of the Papilla of Vater, which could be identified also by magnetic resonance cholangiopancreatography, were shown by ERCP. Dynamic computed tomography demonstrated a hypervascular lesion of the pancreas head. Celiac and superior mesenteric angiography showed a typical racemose vascular network with early identification of the portal venous system. All of these findings confirmed the diagnosis of pancreatic AVM. As a radical treatment for this patient, pylorus preserving pancreatoduodenectomy was the choice for complete removal of the arteriovenous fistulous networks inside the pancreas head. Microscopic examination of the resected specimens revealed numerous dilated arteriovenous fistulous vessels within the pancreas parenchyma. The surgery resulted in complete disappearance of pain just after the operation. There has been no recurrence of symptoms or the imaging diagnostic signs.

Key words
pancreatic arteriovenous malformation, magnetic resonance cholangiopancreatography, doppler ultrasonography

Reprint requests
Shuji Suzuki Hachioji Digestive Disease Hospital
3-18-1 Koyasu, Hachioji-city, 192-0904 JAPAN

Accepted
April 22, 1998

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