A Case of Arteriovenous Malformation of the Pancreatic Head -Successful Treatment by Emergency Pylorus Preserving Pancreaticoduodenectomy

Hiroyuki Nishi, Masaaki Nakahara, Nobuo Ogino, Tetsuo Kido, Kazuyasu Nakao and Masahiko Tsujimoto^*

Departments of Surgery and Pathology^*,Osaka Police Hospital

A case of arteriovenous malformation (AVM) of the pancreatic head, successfully treated by emergency pylorus preserving pancreaticoduodenectomy, is reported. A 57-year-old man was referred with abdominal pain and gastrointestinal bleeding due to a duodenal ulcer. Abdominal ultrasonography and CT scan showed a tumor in the pancreatic head. Celiac and superior mesenteric angiography showed a typical racemose vascular network with early identification of the portal venous system. A diagnosis of AVM was made. Though transarterial embolization was performed twice, gastrointestinal bleeding due to the duodenal ulcer could not be stopped and he went into shock. Emergency pylorus preserving pancreaticoduodenectomy was performed. Histological examination revealed abundant abnormal vessels including arteries and veins. The postoperative clinical course was severe, but the patient recovered and was discharged on the 76th postoperative day. There has been no recurrence of symptoms or the imaging diagnostic signs.

Key words
pancreatic arteriovenous malformation, pylorus preserving pancreaticoduodenectomy

Reprint requests
Hiroyuki Nishi Osaka Police Hospital 10-31 Kitayama-chou, Tennouji-ku, Osaka, 543-0035 JAPAN

Accepted
May 23, 2000

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