Pancreatic duct arteriovenous fistula and the metastatic fat necrosis syndrome

Trapp, Robert G.; Breuer, Richard I.; Crampton, Arthur R.; Davis, J. H.; Derman, Richard E.; Larson, Richard H.; Victor, Thomas A.

doi:10.1007/bf01297128

Cited by 22 publications

(17 citation statements)

References 15 publications

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“…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

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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.

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Section: Introductionmentioning

confidence: 91%

Management of pancreatic arteriovenous malformation

Nishiyama¹,

Kawanishi²,

Mitsuhashi³

et al. 2000

Journal of Hepato-Biliary-Pancreatic Surgery

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“…3,7,[16][17][18][19][20][21] Pancreatitis can cause vascular damage including thrombosis or erosion of intrapancreatic and peripancreatic vessels by the direct effect of pancreatic enzymes. 5,22 A case with a pancreatic pseudocyst eroding into both vascular and ductal structures, producing a pancreatic duct arteriovenous fistula was reported. 5 In this case, pancreatic AVM and acute pancreatitis were revealed at the same time and this patient had no history of trauma or tumor.…”

Section: -14mentioning

confidence: 99%

“…5,22 A case with a pancreatic pseudocyst eroding into both vascular and ductal structures, producing a pancreatic duct arteriovenous fistula was reported. 5 In this case, pancreatic AVM and acute pancreatitis were revealed at the same time and this patient had no history of trauma or tumor. Therefore, this case is probably congenital disease, but not a secondary change due to pancreatitis.…”

Section: -14mentioning

confidence: 99%

A Case of Recurrent Acute Pancreatitis due to Pancreatic Arteriovenous Malformation

Choi¹,

Lee²,

Kwak³

et al. 2010

Gut Liver

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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)

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“…Similar cases have been reported in the literature. 4,17 Cases have also been reported in which the serum pancreatic enzymes remain elevated despite resolution of the cutaneous lesions, 16,18 and in which subsequent attacks of pancreatitis do not cause cutaneous lesions. 18 Fat necrosis has been reproduced in rats injected with pancreatic extract into the peritoneal omentum.…”

Section: Discussionmentioning

confidence: 99%

A fatal case of pancreatic panniculitis presenting in a young patient with systemic lupus

et al. 2000

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Background: Subcutaneous fat necrosis associated with pancreatic disease is a rare event. The clinical cutaneous findings are non‐specific erythematous nodules with central softening located predominantly on the lower extremities. The histopathologic features of these lesions are very characteristic and diagnostic. Methods: We present an unusual case of pancreatic panniculitis associated with lupus pancreatitis in a 21‐year‐old African American female. The patient presented with lower extremity skin nodules, arthralgia, and serositis prior to the diagnosis of systemic lupus and pancreatitis. The skin lesions progressed despite normalization of serum pancreatic enzymes. Following femoral vein catheterization for renal dialysis, she developed a large indurated area over the left lower quadrant, flank, groin, and upper thigh measuring 25 cm. She was treated with repeated debridement, tissue grafts, and hyperbaric oxygen because of a clinical suspicion of necrotizing fasciitis. Results: Examination of skin biopsies and debrided tissue revealed the pathognomonic features of pancreatic panniculitis without any evidence of necrotizing fasciitis. Organisms were not detected by tissue examination or microbiologic cultures. Conclusions: This case illustrates the potential role of vascular trauma in the pathogenesis of pancreatic panniculitis.

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Pancreatic duct arteriovenous fistula and the metastatic fat necrosis syndrome

Cited by 22 publications

References 15 publications

Management of pancreatic arteriovenous malformation

Management of pancreatic arteriovenous malformation

A Case of Recurrent Acute Pancreatitis due to Pancreatic Arteriovenous Malformation

A fatal case of pancreatic panniculitis presenting in a young patient with systemic lupus

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