A case of pancreatic arteriovenous malformation creating a common bile duct-duodenal fistula with the onset of hemorrhagic duodenal ulcer

Abstract

A 50-year-old man had been treated for hemorrhagic duodenal ulcer. Although the patient was treated by proton pump inhibitors (PPI), the ulcer did not show any sign of improvement. Therefore, we also examined the pancreas, and obtained CT findings suggestive of arteriovenous malformation (AVM) from the head to the body of the pancreas. Pancreatic AVM was diagnosed based on angiography. He was readmitted for high fever and abdominal pain. On day 2, CT demonstrated a cystic lesion containing gas at the pancreatic head, and CT showed pneumobilia on day 15. The next day, pancreaticoduodenectomy was carried out and a common bile duct-duodenal fistula was confirmed. This report describes a rare case of pancreatic AVM complicated with a common bile duct-duodenal fistula.