A Case of Total Pancreatectomy for Pancreatic Arteriovenous Malformation with Pseudoaneurysm

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  • 仮性動脈瘤を伴う膵動静脈奇形に対し膵全摘術を施行した１例

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Abstract

<p>Our patient was a 59-year-old man who presented with the complaint of orbital pain, and he visited our hospital because his symptoms did not improve. Plain abdominal computed tomography (CT) revealed a tumor lesion with calcification in the pancreatic body. Endoscopic ultrasonography (EUS) revealed that the mass was vascular, and a pseudo-aneurysm due to rupture of a splenic aneurysm was suspected. Abdominal contrast-enhanced CT was performed, which revealed an arteriovenous malformation spreading throughout the pancreas. Hence, total pancreatic resection was deemed necessary. However, the orbital pain reappeared when the patient was waiting for the surgery to commence, and CT revealed a splenic aneurysmal hemorrhage, which improved with conservative treatment, while total pancreatectomy and splenectomy were performed electively. The pancreatic border was difficult to peel off as inflammation and abnormal angiogenesis were recognized. Moreover, the bleeding increased during the detachment. In addition, since the mass was lumped together with portal vein, it was necessary to reconstruct the portal vein. The patient required treatment for stenosis of the bile ductal-jejural anastomosis after the operation; however, the patient was discharged home on the 46th postoperative day. Histological examination revealed a collection of blood vessels, large and small, and atrophy and fibrosis of the peripheral pancreatic erocrine glands. The findings were consistent with pancreatic arteriovenous malformation.</p>

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