Liu Xiaolei, Huang Jia, Tan Haidong, Yang Zhiying
Department of General Surgery, China-Japan Friendship Hospital, Beijing 100029, China.
Medicine (Baltimore). 2018 Dec;97(50):e13285. doi: 10.1097/MD.0000000000013285.
Hemobilia caused by arteriovenous malformation is extremely rare but could be lethal. To date, most reports have been single-case reports, and no literature reviews are available.
A 47-year-old man presented to the emergency department with abdominal pain and fever. He complained of abdominal pain and weight loss for the past 2 months.
Contrast-enhanced computed tomography and magnetic resonance imaging showed a heterogenous lesion located in pancreatic head and tumor was suspected.
Endoscopic retrograde cholangiopancreatography was performed and bleeding from papilla of Vater could be viewed. Nasobiliary drainage was placed to alleviate the pain and jaundice. Emergency laparotomy was performed due to the recurrence of severe pain and bleeding, and pancreatoduodenectomy was then performed. Macroscopic examination showed the ulceration connected with collected vessels which were located in pancreatic head and microscopic examination confirmed the presence of arteriovenous malformation.
The patient recovered uneventfully and was discharged 10 days after the surgery. He is asymptomatic on 4-month follow up.
Arteriovenous malformation is a rare cause of hemobilia, but it could lead to life threatening bleeding. Transarterial embolization could be effective to control the bleeding temporarily, however repeated hemorrhage may occur. Surgical resection may be a better option.
动静脉畸形引起的胆道出血极为罕见，但可能致命。迄今为止，大多数报告为个案报告，尚无文献综述。
一名47岁男性因腹痛和发热就诊于急诊科。他主诉在过去2个月里有腹痛和体重减轻症状。
增强计算机断层扫描和磁共振成像显示胰头部有一个不均匀病变，怀疑为肿瘤。
进行了内镜逆行胰胆管造影，可见来自 Vater 乳头的出血。放置鼻胆管引流以缓解疼痛和黄疸。由于严重疼痛和出血复发，进行了急诊剖腹手术，随后进行了胰十二指肠切除术。宏观检查显示溃疡与位于胰头部的汇集血管相连，微观检查证实存在动静脉畸形。
患者恢复顺利，术后10天出院。4个月随访时无症状。
动静脉畸形是胆道出血的罕见原因，但可导致危及生命的出血。经动脉栓塞可有效暂时控制出血，但可能会反复出血。手术切除可能是更好的选择。
