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Laparoscopic distal pancreatectomy for pancreatic arteriovenous malformation complicated with portal hypertension


1 Gastroenterological Surgery, Spporo Kyoritsu Gorinbashi Hospital; Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
2 Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University; Division of Minimally Invasive Surgery, Hokkaido University Hospital, Sapporo, Japan
3 Gastroenterological Surgery, Spporo Kyoritsu Gorinbashi Hospital, Sapporo, Japan
4 Gastroenterology, Spporo Kyoritsu Gorinbashi Hospital, Sapporo, Japan
5 Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan

Correspondence Address:
Takehiro Abiko,
Sapporo Kyoritsu Gorinbashi Hospital, 1-Chome, Kawazoe 1-Jo, Minami-Ku, Sapporo, 0050802 Hokkaido
Japan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jmas.JMAS_193_20

Pancreatic arteriovenous malformation (PAVM) is defined as a vascular anomaly with an abnormal anastomosis of the arterial and portal networks within the pancreas. Treatment modalities of PAVM include transarterial embolisation (TAE), irradiation and operation. Most patients treated with TAE alone will experience recurrence, so surgery is the best radical treatment. A female patient was admitted to our institution for the treatment of haematemesis. Examination revealed varices in the oesophagus and stomach, collateral circulation development caused by portal hypertension and PAVM of the pancreas. Surgical treatment was intended to reduce left portal hypertension. In this case, collateral circulation were considered dangerous points for unexpected bleeding. TAE was performed on the splenic artery before surgery to reduce blood flow in the areas with collateral circulation. En bloc resection of retroperitoneal tissue using the surgical procedure of radical antegrade modular pancreatosplenectomy was effective to minimise blood loss.


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    -  Abiko T
    -  Ebihara Y
    -  Takeuchi M
    -  Sakamoto H
    -  Takahashi M
    -  Homma H
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2004 Journal of Minimal Access Surgery
Published by Wolters Kluwer - Medknow
Online since 15th August '04