A Case of Arteriovenous Malformation of the Pancreas Head Detected in Conjunction with an Intractable Post-bulbar Duodenal Ulcer.

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  • 難治性十二指腸球後部潰ようを伴ったすい頭部動静脈奇形の１例

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A 52-year-old man complaining of melena and epigastric pain was admitted to hospital. A gastrointestinal fiberscopic examination revealed a deep ulcer on the anal side of the papilla of Vater. A contrast-enhanced abdominal computed tomography demonstrated an enhanced tubular structure at the head of the pancreas. An angiography revealed remarkable hypervascularity in the head of the pancreas and the filling of the portal vein during the early arterial phase. These findings lead to a diagnosis of AVM of the pancreas head. The duodenal ulcer was intractable, and an epidural analgesia was needed to control the pain. A pylorus-preserving pancreatoduodenectomy was performed. A histological examination revealed dilated tortuous vessels in the sponge-like lesions of the pancreatic head. Vascular reconstruction was required because the lesion involved the superior mesenteric vein and portal vein. A bilio-enteric anastomosis and pancreatico-gastrostomy were performed four months after the first resection. The patient's symptoms disappeared and no signs of recurrence have been seen for more than eight postoperative months.

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