A case of pancreatic arteriovenous malformation caused acute pancreatitis
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CASE REPORT
A case of pancreatic arteriovenous malformation caused acute pancreatitis Kohei Nagata1 · Kazuto Tajiri1 · Nozomu Muraishi1 · Saito Kobayashi1 · Kazuto Sibuya2 · Isaku Yoshioka2 · Tsutomu Fujii2 · Shinichi Tanaka3 · Johji Imura3 · Ichiro Yasuda1 Received: 8 February 2020 / Accepted: 3 September 2020 © Japanese Society of Gastroenterology 2020
Abstract Arteriovenous malformation (AVM) in the pancreas rarely causes acute pancreatitis. However, even when it does cause pancreatitis, the pathogenesis is unclear. A 61-year-old man was admitted to our hospital for acute pancreatitis. The findings of computed abdominal tomography, magnetic resonance imaging, and endoscopic ultrasonography revealed pancreatic AVM and hematoma in the tail of the pancreas. These lesions were suspected to be associated with pancreatitis. Although endoscopic retrograde pancreatography could not confirm hemosuccus pancreaticus, distal pancreatectomy was performed because of repeated pancreatitis. The histopathological findings of the resected specimen revealed rupture of the AVM vessels into the main pancreatic ducts. Finally, we considered that intermittent bleeding due to AVM rupture and hematoma formation in the main pancreatic duct caused the repeated pancreatitis. Keywords Pancreatic arteriovenous malformation · Acute pancreatitis · Bleeding
Introduction
Case report
Arteriovenous malformation (AVM) rarely arises in the pancreas. It is generally asymptomatic and most cases are detected incidentally. Few cases are known to present with symptoms such as gastrointestinal bleeding and acute pancreatitis [1]. A previous report suggested ischemia, bleeding, or compression of the pancreatic duct as possible causes of acute pancreatitis [2]. However, the actual causes have not been elucidated.
A 61-year-old Japanese man was admitted to our hospital because of intermittent left upper abdominal pain for 2 months. His hemoglobin level was normal, but laboratory findings showed increased levels of serum amylase (296 U/L; normal range 44–132 U/L) and lipase (786 U/L; normal range 13–49 U/L). He did not have a history of habitual alcohol intake, abdominal injury, or family history of pancreatitis. He had hyperlipidemia, but it was controlled well with medications. Contrast-enhanced computed abdominal tomography (CAT) scan revealed numerous tortuous and dilated vessels in the swollen pancreatic tail. In addition, a hypovascular lesion was also seen in the tail of the pancreas (Fig. 1). Magnetic resonance imaging (MRI) revealed slightly low intensity area on T1-weighted image in the tail of the pancreas and this area also showed low intensity on T2-weighted image (Fig. 2a). In addition, magnetic resonance cholangiopancreatography (MRCP) revealed spotty and irregular high-intensity lesions in the tail of the pancreas (Fig. 2b). There were no other findings, such as bile duct stones or pancreas divisum that might be suggestive causes of pancreatitis. Endoscopic ultrasonography (EUS) also showed a hypoechoic lesion in the tail of the pancre
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