Bleeding esophageal varices associated with pancreatic arteriovenous malformation

Katoh, Hiroyuki; Kojima, Tetsufumi; Okushiba, Shunichi; Shimozawa, Eiji; Tanabe, T.

doi:10.1007/bf01658962

Cited by 19 publications

(6 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The average age at diagnosis was 48.8 years (range, 7 months to 67 years), with a male predominance, although it had been reported to show no sex difference 21. A high proportion (50%) of the patients suffered from the life‐threatening complication of gastrointestinal bleeding, compared with such findings in 7 asymptomatic patients (16.7%) who were diagnosed incidentally.…”

Section: Discussionmentioning

confidence: 96%

See 1 more Smart Citation

Management of pancreatic arteriovenous malformation

Nishiyama¹,

Kawanishi²,

Mitsuhashi³

et al. 2000

Journal of Hepato-Biliary-Pancreatic Surgery

View full text Add to dashboard Cite

Pancreatic arteriovenous malformations (AVM), while extremely rare, are frequently complicated by gastrointestinal bleeding. The elimination of pancreatic AVM is difficult once portal hypertension has developed. We describe herein a patient with congenital AVM of the pancreatic head presenting with recurrent episodes of melena, in whom pylorus-preserving pancreatoduodenectomy provided a means of definitive management. We also review the literature and focus on the diagnostic and therapeutic approaches. Angiography is always necessary to facilitate tactics of treatment, even if diagnosis has been established by non-invasive imaging modalities. To obtain complete regression, total extirpation of the affected organ, or at least the involved portion, should be performed before this disease leads to the lethal complications of gastrointestinal bleeding and portal hypertension. Transcatheter arterial embolization is the only alternative treatment for the control of hemorrhage.

show abstract

Section: Discussionmentioning

confidence: 96%

“…Nevertheless, pancreatic AVM is extremely rare 1. In a search of the English‐language literature, there were only 41 reported cases to the present day . The current report describes a patient with AVM in the pancreatic head involving the adjacent duodenal wall that resulted in gastrointestinal bleeding.…”

Section: Introductionmentioning

confidence: 91%

Management of pancreatic arteriovenous malformation

Nishiyama¹,

Kawanishi²,

Mitsuhashi³

et al. 2000

Journal of Hepato-Biliary-Pancreatic Surgery

View full text Add to dashboard Cite

show abstract

“…Evidence suggests that the Cr-CK system also plays an energetic role in this tissue [11]. Further corroborating evidence for the importance of CK in skeleton formation is that high CK activity is noted in chondrocytes [14,17]. Moreover, it has been noted that CK activity is also required for the development of endochondral bone and is a key enzyme in the cellular energy metabolism of osteoblasts [9].…”

Section: Introductionmentioning

confidence: 87%

Effect of different doses of creatine on the bone in thirty days of supplementation in mice: FT-Raman study

et al. 2011

View full text Add to dashboard Cite

In this study, Raman spectroscopy was employed in order to provide information about the effects of different doses of creatine on bone tissue composition of phosphate apatite (960 cm–1), carbonate apatite (1170 cm–1) representing the mineral content and collagen matrix (amide I, 1665 cm–1). The animals (27 Balb-C male) were divided into three groups (n═ per group): control (CON), supplemented with 0.5 g/kg (Cre-0.5) and with 2.0 g/kg (Cre-2.0) creatine. The experiment was carried out for thirty days. After this time, the right femur of each animal was harvested. The specimens were assessment by FT-Raman spectroscopy and in a total of 81 spectra were acquired in the medial diaphysis of the femur. The Raman data strongly suggest that only the creatine supplementation of 0.5 g/kg effective to the bone constitution. Furthermore, the present results demonstrate that creatine ingestion provokes decrease in the relative presence of carbonate in the chemical constitution of bones. The decrease in the carbonate content can be associated to a significantly bone resistance altered to several mammalians. The analysis evidenced that the mineral concentrations in the Raman spectroscopy could be a feasible method for non-invasive or minimally invasive assessment of bone tissue composition. Probably this high sensitivity can be employed to determine spectral profiles, such as wavelength of maximum absorption and maximum intensity of absorption of each wavelength, of several bone diseases.

show abstract

“…AVMs of the GI tract may be asymptomatic, or may present with pain or GI bleeding. Bleeding usually originates from a ruptured esophageal or gastric varix secondary to portal hypertension (9). Another potential etiology of the hemorrhage may be direct erosion of the AVM into the pancreatic duct or through the adjacent intestinal mucosa as a duodenal ulcer (10).…”

Section: Abstract: Arteriovenous Malformation; Osler-weber-rendu Dismentioning

confidence: 99%

Arteriovenous malformation of the pancreas: A case report and review of literature

et al. 2008

View full text Add to dashboard Cite

E xtrahepatic arteriovenous malformations (AVMs) of the gastrointestinal (GI) tract are rare and mostly congenital anomalies. They are usually asymptomatic but may present with portal hypertension in the absence of primary liver pathology. They are also rare causes of massive GI bleeding. Treatment modalities may include ligation of the afferent artery, embolization of feeding vessels, portocaval shunting, or surgical resection of part or all of the affected organ (1).We report a case of a patient with an AVM in the head of the pancreas, which caused massive GI bleeding that recurred after embolization and which was subsequently treated with a pyloruspreserving Whipple pancreaticoduodenectomy. The present case report also highlights the recent developments in the diagnosis and treatment of arterioportal malformations. CASE prESEntAtionA 45-year-old woman was admitted to our hospital with significant upper GI bleeding. She had no history of liver disease, chronic pancreatitis or alcohol abuse. Upper GI endoscopy showed grade II esophageal and gastric varices. A transjugular liver biopsy was negative for cirrhosis. Celiac arteriography showed a tangle of blood vessels in the region of the head of the pancreas, supplied from branches of the gastroduodenal artery, with early shunting of arterial blood into the portal vein ( Figures 1A and 1B).Subsequent venography demonstrated elevated pressure in the hepatic venous system, with a wedge hepatic vein pressure of 23 mmHg and free hepatic vein pressure of 17 mmHg. This was presumed to be secondary to arteriovenous shunting between the pancreatic branches of the gastroduodenal artery and the portal vein. The patient underwent transcatheter coil embolization of the feeding vessel with relief of symptoms for approximately six months, followed by another episode of GI bleeding. Upper GI endoscopy was repeated and showed grade I esophageal varices. A celiac angiogram showed persistence of the AVM and worsening of portal hypertension, with enlargement of venous collaterals. Re-embolization was not an option at that stage because the gastroduodenal artery had been coil embolized (Figure 2). The patient subsequently underwent a pylorus-preserving Whipple pancreaticoduodenectomy. She recovered uneventfully and has not reported any episodes of GI bleeding since her surgery six years ago. DiSCUSSionAVMs of the GI tract are uncommon and, when present, may be found in the liver or in extrahepatic locations (2). Meyer et al (3) reviewed a series of GI AVMs and found that 78% of these were located in the cecum and the right colon, followed by 10.5% in the jejunum, 5.5% in the ileum, 2.3% in the duodenum, 1.4% in the stomach and 0.9% in the rectum. Only 0.9% were found in the pancreas. Extrahepatic AVMs have been described, including arterioportal malformations between the accessory right hepatic artery, gastroduodenal artery, or superior mesenteric artery and the portal vein. Ninety per cent of AVMs of the pancreas are congenital in origin and 10% to 30% of them are associated with O...

show abstract

Bleeding esophageal varices associated with pancreatic arteriovenous malformation

Cited by 19 publications

References 11 publications

Management of pancreatic arteriovenous malformation

Management of pancreatic arteriovenous malformation

Effect of different doses of creatine on the bone in thirty days of supplementation in mice: FT-Raman study

Arteriovenous malformation of the pancreas: A case report and review of literature

Contact Info

Product

Resources

About