Kiuchi Ryota, Sakaguchi Takanori, Kawabata Toshiki, Jindo Osamu, Uno Akihiro, Fukazawa Atsuko, Matsumoto Keigo, Kaneko Junichi, Suzuki Daijiro, Ookawa Yoshihisa, Kawamura Kenshi, Suzuki Shioto, Suzuki Shohachi
Department of Gastroenterological Surgery, Iwata City Hospital, Iwata, Shizuoka, Japan.
Department of Gastroenterology, Iwata City Hospital, Iwata, Shizuoka, Japan.
Surg Case Rep. 2025;11(1). doi: 10.70352/scrj.cr.24-0117. Epub 2025 Mar 18.
Pancreatic arteriovenous malformation is a rare disease characterized by abnormal vascular connections between arteries and veins. Despite the risk of increased intraoperative blood loss due to abundant blood flow, surgical resection remains the only curative modality for pancreatic arteriovenous malformation. We present a case of pancreatic arteriovenous malformation in which subtotal stomach-preserving pancreaticoduodenectomy was successfully performed following selective arterial embolization to reduce intraoperative blood loss.
A 53-year-old Southeast Asian man was referred to our hospital with abdominal pain. Contrast-enhanced computed tomography revealed enhancement of the pancreatic head and superior mesenteric vein in the early arterial phase, suggesting the presence of an arteriovenous malformation. Maximum intensity projection images and angiography revealed arterial branches from the gastroduodenal artery and superior mesenteric artery to the arteriovenous malformation, subsequently draining into the portal venous circulation. We supposed that abdominal pain resistant to medical treatment was due to the pancreatic arteriovenous malformation, and surgical resection was deemed necessary. Subtotal stomach-preserving pancreaticoduodenectomy was safely performed on the day after arterial embolization of pancreatic arterial branches to reduce intraoperative blood loss. The procedure resulted in an intraoperative blood loss of 336g. The patient was discharged on the 16th postoperative day with no complications and has not experienced abdominal pain since.
Selective arterial embolization prior to pancreaticoduodenectomy against pancreatic arteriovenous malformation is a safe and feasible procedure to reduce intraoperative blood loss.
胰腺动静脉畸形是一种罕见疾病，其特征为动脉与静脉之间存在异常血管连接。尽管由于血流丰富导致术中失血增加的风险，但手术切除仍是胰腺动静脉畸形唯一的治愈方式。我们报告一例胰腺动静脉畸形病例，该病例在选择性动脉栓塞以减少术中失血后成功实施了保留部分胃的胰十二指肠切除术。
一名53岁的东南亚男性因腹痛转诊至我院。增强计算机断层扫描显示在动脉早期胰头和肠系膜上静脉有强化，提示存在动静脉畸形。最大密度投影图像和血管造影显示胃十二指肠动脉和肠系膜上动脉的分支通向动静脉畸形，随后引流至门静脉循环。我们推测药物治疗无效的腹痛是由胰腺动静脉畸形引起的，因此认为有必要进行手术切除。在对胰腺动脉分支进行动脉栓塞以减少术中失血后的次日，安全地实施了保留部分胃的胰十二指肠切除术。该手术术中失血量为336克。患者术后第16天出院，无并发症，此后未再经历腹痛。
针对胰腺动静脉畸形在胰十二指肠切除术前进行选择性动脉栓塞是一种安全可行的减少术中失血的方法。
