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 adminission. 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 recurren 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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References
Halpern M, Turner AF, Cutron BP (1968) Hereditary hemorrhagic teleangiectasia—an angiographic study of abdominal visceral angiodysplasia associated with gastrointestinal hemorrhage Radiology 90:1143–1149
Ishikawa T (1975) Congenital arteriovenous malformations involving the pelvis and retroperitoneum: a case report. Angiography 30:70–74
Mizutani N, Masuda Y, Naito N, Toda T, Yao E, Fukumoto M (1981) Pancreatic arteriovenous malformation in a patient with gastrointestinal hemorhage. Am J Gastroenterol 76:141–144
Hashimoto M, Yamada N, Fukuchi S, Ono Y, Tsurumaru M, Akiyama H, Irimoto M, Matsuya S, Hara M (1983) A case of arteriovenous malformation of the pancreas associated with a para papilla duodenal ulcer and choledocho-duodenal fistula (in Japanese). Nippon Shoukakibyou Gakkai Zasshi (Jpn J Gastroenterol) 80:1496–1500
Noboritani D, Tanaka N, Nakamura A, Fukuoka K, Okafuji K, Nakaya S, Yanagi K, Asada Y, Miura S, Fujisawa M, Ida M (1987) A case of the rupture from esophageal varix due to pancreatic arteriovenous malformation associated with Rendu-Osler-Weber syndrome (in Japanese). Nippon Shoukakibyou Gakkai Zasshi (Jpn J Gastroenterol) 84:2251
Kojima T, Shirota T, Kakei N, Chiba N, Tsushima K, Kurosawa S, Wang SY, Kawahara H, Sakita T, Araki S, Maeda M, Tateno I, Masaki Y, Sakurai K, Hamamoto T, Nagayama T (1987) An autopsy case of arteriovenous malformation of the pancreatic head revealed portal hypertension (in Japanese). Nippon Shoukakibyou Gakkai Zasshi (Jpn J Gastroenterol) 84:1855–1858
Morita Y, Saito H, Shinohara M, Fujita N, Irie G, Kumagaya M, Tashiro A, Sasaki H (1988) Clinico-radiological diagnosis pancreatic arteriovenous malformations (in Japanese). Tan To Sui (J Bil Panc) 9:605–613
Katoh H, Tanabe T (1993) Congenital arteriovenous malformation of the pancreas with jaundice and a duodenal ulcer: report of a case. Surg Today 23:1108–1112
Sugimori S, Nakajima Y, Kanehiro H, Yoshimura A, Ko S, Nakano H, Uchida H (1995) A resected case of arteriovenous malformation at the pancreas head (in Japanese with English abstract). Nippon Shoukakigeka Gakkai Zasshi (Jpn J Gastroenterol Surg) 28:1090–1094
Akaki S, Makihata E, Kimoto M, Kanazawa Y, Hiraki A, Mitsunaga M (1995) A Case of pancreatic arteriovenous malformation (in Japanese with English abstract). Rinshou Houshasen (Jpn J Clin Radiol) 40:725–727
Imano E, Miyamoto T, Shimotani M, Yasumaru M, Murata H, Sato T, Ishigami Y, Kanda T, Shimizu Y (1995) A case of pancreatic arteriovenous malformation—understanding its pathophysiology with a color Doppler ultrasonography (in Japanese). Nippon Shoukakibyou Gakkai Zasshi (Jpn J Gastroenterol) 92:1799–1803
Lande A, Bedford A, Schechter LS (1976) The spectrum of angiographic findings in Odler-Weber-Rendu disease. Angiography 27:223–240
Moore JD, Thompson NW, Appleman HD, Foley D (1976) Arteriovenous malformations of the gastrointestinal tract. Arch Surg 111:381–389
Chuang VP, Pulmona CM, Walter JF, Cho KJ (1977) Angiography of pancreatic arteriovenous malformation. Am J Roentgenol 129:1015–1018
Lawhon NC (1980) Pancreatic arteriovenous malformation. J Miss State Med Assoc 21:184–185
Gomes A, Mail WP, Oppenheim WL (1982) Embolization therapy in the management of congenital arteriovenous malformations. Diagn Radiol 144:41–49
Haitjema T, Disch E, Overtoom TTC, Westermann CJJ, Lammers JWJ (1995) Screening of family members of pateints with hereditary hemorrhagic teleangiectasia. am J Med 99:519–524
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Uda, O., Aoki, T., Tsuchida, A. et al. Pancreatic arteriovenous malformation observed to bleed from the bile duct and a duodenal ulcer: Report of a case. Surg Today 29, 462–466 (1999). https://doi.org/10.1007/BF02483042
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DOI: https://doi.org/10.1007/BF02483042