Arora Anil, Tyagi Pankaj, Kirnake Vijendra, Singla Vikas, Sharma Praveen, Bansal Naresh, Ghuman Samarjit Singh, Jain Deepali, Kumar Ashish
Sir Ganga Ram Hospital and Department of Gastroenterology and Hepatology, Ganga Ram Institute for Postgraduate Medical Education and Research, New Delhi, India.
JOP. 2013 May 10;14(3):292-5. doi: 10.6092/1590-8577/1404.
Upper gastrointestinal bleeding is one of the most common emergencies in gastroenterology. The common causes of the upper gastrointestinal bleeding include peptic ulcer disease, gastric erosive mucosal disease and portal hypertension. Gastrointestinal arteriovenous malformation is a less common cause of gastrointestinal bleeding and these arteriovenous malformation are most commonly located in the large and small intestine. Pancreatic arteriovenous malformation is a rare condition in which there is tumor-like formation or vascular anomaly built up via an aberrant bypass anastomosis of the arterial and venous systems in the pancreas. Splenic artery is most commonly involved (42%), followed by gastroduodenal artery (22%) and small pancreatic arteries (25%). Clinically it may present as gastrointestinal hemorrhage which is occasionally fatal. Other presentations are abdominal pain, pancreatitis, duodenal ulcer, jaundice, and portal hypertension.
We present a rare case of pancreatic arteriovenous malformation presenting as massive upper gastrointestinal bleeding.
Since early surgery is a life saving treatment for such cases, hence, a high index of suspicion should be maintained especially when massive bleeding is detected from the medial wall of second part of duodenum.
上消化道出血是胃肠病学中最常见的急症之一。上消化道出血的常见原因包括消化性溃疡病、胃黏膜糜烂性疾病和门静脉高压。胃肠道动静脉畸形是胃肠道出血的较不常见原因，这些动静脉畸形最常见于大肠和小肠。胰腺动静脉畸形是一种罕见的病症，其中存在通过胰腺中动脉和静脉系统的异常旁路吻合形成的肿瘤样结构或血管异常。脾动脉最常受累（42%），其次是胃十二指肠动脉（22%）和胰腺小动脉（25%）。临床上它可能表现为胃肠道出血，偶尔会致命。其他表现为腹痛、胰腺炎、十二指肠溃疡、黄疸和门静脉高压。
我们报告一例罕见的以大量上消化道出血为表现的胰腺动静脉畸形病例。
由于早期手术是此类病例的救命治疗方法，因此，尤其当十二指肠第二部内侧壁出现大量出血时，应保持高度怀疑。
