1Fahad Mohammed Aldawsari
1King Abdulaziz Medical City
Pancreatico-duodenal Arteriovenous Malformation is a rare entity and few cases reported in the literature review.Those patients have variable clinical presentations from asymptomatic to upper GI bleeding and portal hypertension.The definitive treatment is surgical especially at early stage.However, other options such as conservative, embolization,irradiation and TIPS can be effective in selective patients and situations. A 44 years old man patient presented to our Hospital with on / off abdominal pain and episode of upper GI bleeding .He is vitally is hypotensive and his laboratory investigation demonstrated dropped haemoglobin and leukocytosis.Routine CT abdomen and pelvis was done which showed contained duodenal perforation and incidental discovered of pancreatic head and body AVM.During COVID 19 crises , lockdown of operating rooms were reserved for emergency cases only therefore , multidisciplinary team was consulted and end discussion was for IR referral for further management.Diagnostic Abdominal angiography selecting celiac and superior mesenteric artery was done which revealed pancreatic-duodenal and pancreatic body AVM with early filling of portal vein.No clear active arterial extravasation.The pancreatic-duodenal AVM which was then treated with 2 sessions of embolization using Coil and Onyx.Post embolization angiogram showed around 80% of pancreatic AVM was resolved.9 days follow-up showed clinical and imaging improvement in term of near total resolution of the AVM and healed perforation.Patient discharged with 6 month follow-up in IR clinic.
Material(s) and Method(s):
Case report study of patient conducted form 2020-2021
Post embolization angiogram showed around 80% of pancreatic AVM was resolved.9 days follow-up showed clinical and imaging improvement in term of near total resolution of the AVM and healed perforation. Patient discharged with 6 month follow-up in IR clinic.
Pancreatico-duodenal Arteriovenous Malformation Embolization is safe and effective in selective patients.