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Management of pancreatic arteriovenous malformation
R Nishiyama1, Y Kawanishi, H Mitsuhashi
1Hamamatsu Social Insurance Hospital, Hamamatsu, Japan.
Abstract:
Pancreatic arteriovenous malformations (AVM), while extremely rare, are frequently complicated by gastrointestinal bleeding. The elimination of pancreatic AVM is difficult once portal hypertension has developed. We describe herein a patient with congenital AVM of the pancreatic head presenting with recurrent episodes of melena, in whom pylorus-preserving pancreatoduodenectomy provided a means of definitive management. We also review the literature and focus on the diagnostic and therapeutic approaches. Angiography is always necessary to facilitate tactics of treatment, even if diagnosis has been established by non-invasive imaging modalities. To obtain complete regression, total extirpation of the affected organ, or at least the involved portion, should be performed before this disease leads to the lethal complications of gastrointestinal bleeding and portal hypertension. Transcatheter arterial embolization is the only alternative treatment for the control of hemorrhage.
Insights
Pancreatic arteriovenous malformations (AVM) can cause severe gastrointestinal bleeding. Surgical removal, like pancreatoduodenectomy, offers definitive treatment for pancreatic AVM before complications arise.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Interventional Radiology
Background:
- Pancreatic arteriovenous malformations (AVM) are rare vascular anomalies.
- These malformations often present with significant gastrointestinal bleeding.
- Portal hypertension complicates the management of pancreatic AVM.
Observation:
- A case of congenital pancreatic head AVM presenting with recurrent melena is described.
- Pylorus-preserving pancreatoduodenectomy was successfully employed for definitive management.
- Literature review highlights diagnostic and therapeutic strategies for pancreatic AVM.
Findings:
- Angiography is crucial for treatment planning, complementing non-invasive imaging.
- Complete surgical extirpation of the affected pancreatic portion is recommended for regression.
- Transcatheter arterial embolization serves as an alternative for hemorrhage control.
Implications:
- Early diagnosis and surgical intervention are vital to prevent lethal complications.
- Pylorus-preserving pancreatoduodenectomy is a viable option for pancreatic head AVM.
- Multidisciplinary approaches are essential for managing complex pancreatic vascular lesions.