J Korean Soc Radiol.  2016 Oct;75(4):271-275. 10.3348/jksr.2016.75.4.271.

Transcatheter Arterial Embolization of Pancreatic Arteriovenous Malformation Presenting as Retroperitoneal Bleeding: A Case Report

• Ji SW
• Kang UR
• Kim YH

• KMID: 2353677
• DOI: http://doi.org/10.3348/jksr.2016.75.4.271

Abstract

We report a case of pancreatic arteriovenous malformation presenting mesenteric and peripancreatic hemorrhages. A 62-year-old man presented to the emergency department of our hospital with acute periumbilical pain. Diffuse mesenteric and peripancreatic hemorrhages and an approximately 1 cm aneurysmal sac were observed on contrast-enhanced computed tomography. Celiac and superior mesenteric angiography revealed pancreatic arteriovenous malformation, which was then treated with transcatheter arterial embolization using n-butyl-2-cyanoacrylate. Complete obliteration of pancreatic arteriovenous malformation was evident on a follow-up computed tomography performed 2 months later.

MeSH Terms

Aneurysm
Angiography
Arteriovenous Malformations*
Embolization, Therapeutic
Emergency Service, Hospital
Enbucrilate
Follow-Up Studies
Hemorrhage*
Humans
Middle Aged
Pancreas
Enbucrilate

Figure

• 

  Fig. 1 Transcatheter arterial embolization of pancreatic arteriovenous malformation in a 62-year-old man presenting as retroperitoneal bleeding. A. Portal-phase dynamic computed tomographic image shows an enhanced nodular vascular lesion with mesenteric and peripancreatic hemorrhages adjacent to the pancreatic head (arrowheads). The superior mesenteric vein is compressed by hematoma (arrow). B. A selective superior mesenteric arteriogram shows a nodular nidus at the pancreatic head that is fed by a small branch of the inferior pancreaticoduodenal artery (arrow). C. Delayed superior mesenteric arteriogram shows the tortuous drainage vein (arrowhead) to the superior mesenteric vein and early visualization of the portal vein (arrow). D. A selective celiac arteriogram shows a second feeding artery through the dorsal pancreatic artery that originates from the proximal common hepatic artery just distal to the splenic artery bifurcation (arrow). E. A selective dorsal pancreatic arteriogram through the pancreaticoduodenal arcade shows early visualization of the portal vein (arrow). F. A post-procedural angiogram shows complete exclusion of the feeding arteries, nidus, and aberrant draining vein. G. Indirect portogram after procedure shows patent portal venous flow despite spreading of several NBCA droplets in liver. H. A computed tomographic scan obtained 2 months after the procedure, shows complete embolization of the pancreatic arteriovenous malformation and improved retroperitoneal hemorrhage. NBCA = n-buty1-2-cyanoacrylate

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