A case of duodenal hemorrhage due to arteriovenous malformation around a serous cystic neoplasm

Abstract

BackgroundNo reports have so far described arteriovenous malformation (AVM) in the pancreas caused by a tumor. We herein report a case of pancreatoduodenectomy for a patient who developed duodenal hemorrhage due to AVM developed around serous cystic neoplasm (SCN) of the pancreas.Case presentationA 79-year-old man was referred to our hospital because of anemia (Hb 7.4 g/dl) and pancreatic head tumor. Computed tomography showed microcystic-type SCN, 87 mm in size, in the pancreatic head. Vascular hyperplasia had developed around the cystic lesion. Upper gastrointestinal endoscopy and colonoscopy did not reveal the cause of anemia, so the patient was followed closely without hemostatic therapy. Iron preparations had improved the anemia. Three months later, the patient developed anemia (Hb 5.8 g/dl) again. Gastrointestinal endoscopy showed oozing from the mucosa in the duodenum via the swollen vascular hyperplasia. He was diagnosed as duodenal hemorrhage from the blood vessels around SCN. Pancreatoduodenectomy was performed to control repeated duodenal bleeding. A histopathological examination revealed that the cystic lesion in the pancreatic head was SCN, and the AVM developed around SCN and duodenum, causing repeated duodenal hemorrhage. The patient was discharged on postoperative day 22. Nine months after surgery, the patient had no recurrence of anemia.ConclusionsThere have been no reports of duodenal hemorrhage due to acquired pancreatic AVM around pancreatic tumor, including SCN. We successfully treated a case of duodenal hemorrhage due to pancreatic AVM around SCN by pancreatoduodenectomy.

Arteriovenous malformation in the pancreatic head initially mimicking a hypervascular mass treated with duodenum-preserving pancreatic head resection: a case report

“…We identified relevant articles pertaining to Ph-AVM in the English literature available on the PubMed electronic database. In total, 73 cases of Ph-AVM, including our case, have been reported on PubMed from 1968 to 2019, based on searches using "pancreas", "head", and "arteriovenous malformation" as keywords [4,5,[12][13][14][15][16][17][18][19][20][21][22] (Table 1). Sixty-four cases involved men (87.7%) and nine involved women (12.3%).…”

Cystic mass with arteriovenous malformations of the lesser omentum

“…The aetiology is unclear. The proposed causes include congenital malformation and acquired causes such as trauma or inflammation 3 …”

An unusual presentation of pancreatic serous cystadenoma

“…Haemorrhagic complication of PCNs is very rare, with only a handful of cases reported in the literature. [7][8][9] Pancreatic serous cystic neoplasms are a wholly benign entity. Early studies suggested that serous cyst adenomas had low malignant potential however there is a growing body of evidence to support that serous cystadenomas are indeed the only PCNs that are benign.…”