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Bleeding esophageal varices associated with pancreatic arteriovenous malformation
H Katoh1, T Kojima, S Okushiba
1Second Department of Surgery, Hokkaido University School of Medicine, Sapporo, Japan.
Abstract:
Three cases of bleeding esophageal varices associated with arteriovenous malformation of the pancreas have been observed over the last 7 years. In 1 case, arteriovenous malformation (AVM) was the cause of the portal hypertension; thus, it was considered to be a "primary lesion." In the other cases, liver cirrhosis was the cause of the portal hypertension, and the AVM, which originally was a minor pathology, became significant as the portal hypertension progressed, thus making it a "secondary lesion." In the case of a "primary lesion," resection of the lesion is the preferred treatment for bleeding varices, but our case had multiple lesions, and excision was problematic. In the case of bleeding varices caused by liver cirrhosis, if liver function is normal, surgical treatment of both the varices and the AVM is recommended, while if the liver function is abnormal, repeated sclerotherapy is the best mode of therapy.
Insights
Arteriovenous malformations (AVMs) of the pancreas can cause bleeding esophageal varices. Treatment depends on whether the AVM is the primary cause or secondary to liver cirrhosis.
Area of Science:
- Gastroenterology
- Vascular Surgery
- Hepatology
Background:
- Esophageal varices are a serious complication of portal hypertension.
- Pancreatic arteriovenous malformations (AVMs) are rare vascular anomalies.
- The relationship between pancreatic AVMs and bleeding varices requires further investigation.
Observation:
- Three cases of bleeding esophageal varices associated with pancreatic AVMs were observed over seven years.
- In one case, the AVM was the primary cause of portal hypertension.
- In two cases, liver cirrhosis was the primary cause, with the AVM becoming significant secondarily.
Findings:
- For primary AVM-induced portal hypertension, lesion resection is preferred, though challenging with multiple lesions.
- For secondary AVMs in liver cirrhosis with normal liver function, combined surgical treatment of varices and AVM is recommended.
- For secondary AVMs with abnormal liver function, repeated sclerotherapy is the preferred management.
Implications:
- This study highlights the importance of considering pancreatic AVMs in patients with unexplained esophageal varices.
- Management strategies should be tailored based on the etiology of portal hypertension and liver function.
- Further research is needed to elucidate the pathogenesis and optimize treatment for this rare condition.