Concurrent Pancreatic Head and Tail Arteriovenous Malformations in a 40-Year-Old Gentleman: The First Published Report

  • Asma Alnajjar College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
  • Ahmed Abu-Zaid College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
  • Dina A Al-omem College of Medicine, Qassim University, Riyadh, Saudi Arabia
  • Daniah S Aloufi College of Medicine, Taiba University, Madinah, Saudi Arabia
  • Ayman Azzam Faculty of Medicine, Alexandria University, Alexandria, Saudi Arabia
  • Tarek Amin Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
Keywords: Arteriovenous Malformations, Case Reports, Pancreas

Abstract

Context Pancreatic arteriovenous malformations (AVMs) are uncommon in the gastrointestinal tract. Less than 100 cases have been identified in the medical literature. Approximately 10% of all pancreatic AVMs are sporadic. Case Report Herein, we report the first documented case of sporadic concurrent pancreatic head and tail AVMs in a 40-year-old gentleman who presented with a 10-day history of epigastric pain and one episode of hematemesis. Patient denied any history of traumatic incidents, cigarette smoking, alcohol abuse, chronic gastric/duodenal ulcer, chronic pancreatitis, chronic hepatic disease, difficulty swallowing, respiratory compromise, or weight loss. Physical examination and laboratory results were unremarkable. Contrast-enhanced computed tomography scan showed two hypervascular masses involving the pancreatic head and tail. The celiac trunk angiogram showed proliferating vascular networks involving the pancreatic head and tail. The superior mesenteric angiogram demonstrated significant vascular contribution to the pancreatic head arteriovenous malformation only. Due to the extreme locations of pancreatic AVMs in the head and tail, surgical resection of both lesions (leaving behind the normal pancreatic body) was not possible. Instead, patient underwent intraoperative irradiation therapy (IORT). During the procedure, patient was surgically operated to retract healthy organs/tissues, and then a single concentrated dose of radiation therapy was precisely applied to both pancreatic head and tail AVM lesions. Patient had an uneventful postoperative recovery and was discharged home on the second postoperative day in stable condition. The patient is to be seen in clinic in a 4-month-period during which patient will be completing a 12-month period of postoperative IORT. Conclusion This is the first documented case of sporadic concurrent pancreatic head and tail AVMs. Angiography is the gold standard diagnostic modality.

Image: Two large vascular arteriovenous malformations involving both the pancreatic head and tail.

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References

Meyer CT, Troncale FJ, Galloway S, Sheahan DG. Arteriovenous malformations of the bowel: an analysis of 22 cases and a review of the literature. Medicine (Baltimore). 1981; 60:36-48. [PMID:6969839]

Takemoto I, Tsuda M, Yano Y, Miyazaki H, Yamada H, Azuma T, Maeda S. Pancreatic arteriovenous malformation combined with portal thrombosis. Intern Med. 2007; 46:233-236. [PMID:17329918]

Nishiyama R, Kawanishi Y, Mitsuhashi H, Kanai T, Ohba K, Mori T, Hamabe N. Management of pancreatic arteriovenous malformation. J Hepatobiliary Pancreat Surg. 2000; 7:438-442. [PMID:11180867]

Charalabopoulos A, Macheras N, Krivan S, Petropoulos K, Misiakos E, Macheras A. Arteriovenous malformation of the pancreas. Case Rep Med. 2011; 2011:612-657. [PMID:21765845]

Shearer DD, Demos TC, Sichlau MJ. Pancreatic arteriovenous malformation: A case report and literature review. J Radiol Case Rep.

; 5:8-13. [PMID:22470807]

Yoon JH, Han SS, Cha SS, Lee SJ. Color Doppler ultrasonography of a pancreatic arteriovenous malformation. J Ultrasound Med. 2005; 24:113-117. [PMID:15615937]

Koito K, Namieno T, Nagakawa T, Ichimura T, Hirokawa N, Mukaiya M, Hirata K. Congenital arteriovenous malformation of the pancreas: its diagnostic features on images. Pancreas. 2001; 22:267-73. [PMID:11291928]

Sato M, Kishi K, Shirai S, Suwa K, Kimura M, Kawai N, Tanihata H. Radiation therapy for a massive arteriovenous malformation of the pancreas. AJR Am J Roentgenol. 2003; 181:1627-1628. [PMID:14627586]

Halpern M, Turner AF, Citron BP. Hereditary hemorrhagic telangiectasia. An angiographic study of abdominal visceral angiodysplasias associated with gastrointestinal hemorrhage. Radiology. 1968; 90:1143-1149. [PMID:5656734]

Loria LE, Tsuchiya R, Harada N, Tomioka T, Izawa K, Ura K, Ozeki K. Congenital mesenteric arterio-portal fistula: report of a case. Jpn J Surg. 1988; 18:351-358. [PMID:3043070]

Barth MM, Khwaja K, Faintuch S, Rabkin D. Transarterial and transvenous embolotherapy of arteriovenous fistulas in the transplanted pancreas. J Vasc Interv Radiol. 2008; 19:1231-1235. [PMID:18656019]

Rezende MB, Bramhall S, Hayes T, Olliff S, Buckels JA, Candinas D. Pancreatic arteriovenous malformation. Dig Surg. 2003; 20:65-69. [PMID:12637811]

Makhoul F, Kaur P, Johnston TD, Jeon H, Gedaly R, Ranjan D. Arteriovenous malformation of the pancreas: A case report and review of literature. Int J Angiol. 2008; 17:211-213. [PMID:22477452]

Chuang VP, Pulmano CM, Walter JF, Cho KJ. Angiography of pancreatic arteriovenuos malformation. AJR Am J Roentgenol. 1977; 129:1015-1018. [PMID:413351]

Katoh H, Kojima T, Okushiba S, Shimozawa E, Tanabe T. Bleeding esophageal varices associated with pancreatic arteriovenous malformation. World J Surg. 1991; 15:57-60. [PMID:1994606]

Ohtani N, Kimoto K, Yoshida S, Tanaka T, Inokuchi H, Kawai K. Pancreatic arteriovenous malformation with pancreatitis involving a pancreatico-venous fistula. Gastroenterol Jpn. 1992; 27:115-120. [PMID:1555741]

Jeong WJ, Son JM, Kim GH, Heo J, Kang DH, Song GA, Jo M. A case of hemosuccus pancreaticus in arteriovenous malformation. Korean J Med

; 68:436-440.

Koito K, Namieno T, Nagakawa T, Morita K. Diagnosis of arteriovenous malformation of the pancreas by color Doppler ultrasonography. Abdom Imaging. 1998; 23:84-86. [PMID:9437070]

Yamamoto T, Takeuchi K, Honjo H, Sakurai N, Okuda C, Kuyama Y. Pancreatic arteriovenous malformation presenting as cysts: Doppler sonographic diagnosis. J Clin Ultrasound. 2000; 28:365-367. [PMID:10934338]

Kurosaki M, Hattori K, Minato Y, et al. Asymptomatic arteriovenous malformation of the pancreas. Demonstration by Doppler ultrasonography and magnetic resonance imaging. Dig Dis Sci. 1993; 38:1342-1346. [PMID:8325195]

Tano S, Ueno N, Ueno T, Wada S, Aizawa T, Kimura K. Pancreatic arteriovenous malformation with duodenal ulcer. Demonstration by color Doppler ultrasonography. Dig Dis Sci. 1996; 41:1232-1237. [PMID:8654157]

Uchida E, Aimoto T, Nakamura Y, et al. Pancreatic arteriovenous malformation involving adjacent duodenum with gastrointestinal bleeding: report of a case. J Nippon Med Sch. 2006; 73:346-350. [PMID:17220587]

Choi JK, Lee SH, Kwak MS, Kim JH, Jang ES, Hwang SW, Hwang JH. A Case of Recurrent Acute Pancreatitis due to Pancreatic Arteriovenous Malformation. Gut Liver. 2010; 4:135-139. [PMID:20479928]

Arora A, Tyagi P, Kirnake V, Singla V, Sharma P, Bansal N, Ghuman SS. Unusual cause of massive upper gastrointestinal bleeding: a pancreatic arteriovenous malformation. JOP. 2013; 14:292-295. [PMID:23669484]

Poon RT, Poon J. Massive GI bleeding due to a duodenal arteriovenous malformation. Gastrointest Endosc. 2000; 52:101-104. [PMID:10882974]

Two large vascular arteriovenous malformations involving both the pancreatic head and tail
Published
2014-05-27
How to Cite
AlnajjarA., Abu-ZaidA., Al-omemD., AloufiD., AzzamA., & AminT. (2014). Concurrent Pancreatic Head and Tail Arteriovenous Malformations in a 40-Year-Old Gentleman: The First Published Report. JOP. Journal of the Pancreas, 15(3), 269-273. https://doi.org/10.6092/1590-8577/2392
Section
CASE REPORTS