Inoue Shotaro, Ueo Tetsuya, Yonemasu Hirotoshi, Ishida Tetsuya, Fukuda Masahide, Togo Kazumi, Yanai Yuka, Nagamatsu Hideyasu, Narita Ryoichi, Murakami Kazunari
Department of Gastroenterology, Oita Red Cross Hospital.
Department of Pathology, Oita Red Cross Hospital.
Nihon Shokakibyo Gakkai Zasshi. 2017;114(5):846-853. doi: 10.11405/nisshoshi.114.846.
A 62-year-old man with epigastralgia was referred to our hospital for the evaluation of an intractable duodenal ulcer, which did not improve following proton pump inhibitor treatment. An upper gastrointestinal endoscopy revealed that the base of the ulcer was gray-white in color with conspicuous fibrosis tissue, unlike the appearance of common ulcers. A contrast-enhanced abdominal CT scan and angiography revealed tortuous and dilated vascular structures in the pancreatic head. This was diagnosed as a pancreatic arteriovenous malformation. We suggest that the intractable duodenal ulcer was caused by the pancreatic arteriovenous malformation. Therefore, we performed a pancreaticoduodenectomy. Pancreatic arteriovenous malformations should be considered as one of the causes of treatment-resistant duodenal ulcers.
一名62岁上腹部疼痛的男性因难治性十二指肠溃疡来我院评估，在接受质子泵抑制剂治疗后溃疡未改善。上消化道内镜检查显示，溃疡底部呈灰白色，有明显的纤维化组织，与普通溃疡外观不同。腹部增强CT扫描和血管造影显示胰头有迂曲扩张的血管结构。诊断为胰腺动静脉畸形。我们认为难治性十二指肠溃疡是由胰腺动静脉畸形引起的。因此，我们进行了胰十二指肠切除术。胰腺动静脉畸形应被视为治疗抵抗性十二指肠溃疡的病因之一。
