A Case of Recurrent Acute Pancreatitis due to Pancreatic Arteriovenous Malformation

Abstract

Pancreatic arteriovenous malformation (AVM) is an extremely rare condition with various clinical manifestations. We report herein a case of recurrent acute pancreatitis due to pancreatic AVM in a 49-year-old man. This patient presented with epigastric pain that had developed after consuming alcohol 2 days prior to admission. Serum amylase and lipase levels were elevated and computed tomography revealed focal low-attenuation lesions with peripancreatic infiltrations in the pancreatic tail and multiple collateral vessels around the low-attenuation lesions. He was diagnosed with acute pancreatitis and pancreatic AVM. Although he had stopped drinking after the first attack of acute pancreatitis, his pancreatitis recurred twice within 3 months. He underwent a distal pancreatectomy after the third attack of acute pancreatitis. He was free of symptoms for 2 years after the pancreatectomy. (Gut Liver 2010;4:135-139)

Transcatheter embolization of pancreatic arteriovenous malformation associated with recurrent acute pancreatitis

“…[ 9 23 ] In the present case, like in most of the other cases previously reported, PAVM and pancreatitis were detected simultaneously with no past history of trauma or tumor in the patient, suggesting that the PAVM was probably congenital. [ 5 9 22 23 ]…”

“…[ 5 9 13 21 22 23 ] The mechanisms by which PAVM can cause pancreatitis may be classified into three types: (i) By bleeding from PAVM extending into the pancreatic duct,[ 21 ] (ii) ischemic injury due to the PAVM stealing flow from normal surrounding pancreatic parenchyma,[ 5 ] and (iii) pancreatic ductal compression caused by PAVM. [ 9 ] Cases of pancreatitis causing PAVM have also been reported and have been proposed to be due to the vascular damage caused by the direct effect of pancreatic enzymes. [ 9 23 ] In the present case, like in most of the other cases previously reported, PAVM and pancreatitis were detected simultaneously with no past history of trauma or tumor in the patient, suggesting that the PAVM was probably congenital.…”

“…[ 9 ] Cases of pancreatitis causing PAVM have also been reported and have been proposed to be due to the vascular damage caused by the direct effect of pancreatic enzymes. [ 9 23 ] In the present case, like in most of the other cases previously reported, PAVM and pancreatitis were detected simultaneously with no past history of trauma or tumor in the patient, suggesting that the PAVM was probably congenital. [ 5 9 22 23 ]…”

“…[ 3 ] Though it may be asymptomatic, majority of the cases present with a variety of symptoms including epigastric pain, abdominal distension, and gastrointestinal bleeding. [ 2 3 4 5 6 ] Surgery is considered to be the definitive treatment by many,[ 2 3 7 8 9 ] but there are no universally accepted guidelines and other therapies like transcatheter arterial embolization[ 10 11 12 13 14 15 ] and irradiation[ 16 17 ] have been explored. In asymptomatic patients, a conservative approach has also been tried for a good result.…”

Arteriovenous Malformation with a Retention Cyst of the Pancreas

“…The pathophysiology of pancreatitis with pancreatic AVM has not yet been clarified. The mechanisms of pancreatitis arising from pancreatic AVM may be classified into three types: i) by bleeding from pancreatic AVM extending into the pancreatic duct,8 ii) by ischemic injury due to the pancreatic AVM "stealing" flow from normal surrounding parenchyma like brain AVM,6 iii) by pancreatic duct compression from pancreatic AVM 9. In the present case, like in most of the other previously reported case, pancreatic AVM and pancreatitis were detected simultaneously with no history of trauma or tumor in the patient, suggesting that the pancreatic AVM was congenital.…”