Pancreatic Arteriovenous Malformation Presenting With Gastrointestinal Bleeding and Treated by Transarterial Embolization

Arteriovenous malformation is a rare disease characterized by abnormal vascular connections between arteries and veins. The condition may remain asymptomatic until complicated by hemorrhage. We present a case of arteriovenous malformation in the pancreatic head complicated by upper gastrointestinal bleeding, which was successfully treated by selective transarterial embolization. A 62-year-old man presented with mild epigastric pain and several episodes of melena. Colonoscopy and upper gastrointestinal endoscopy were not diagnostic. Contrast-enhanced computed tomography revealed abnormal enhancement with multiple vascular branches in the pancreatic head, with early enhancement of the portal venous system in the arterial phase, suggesting the presence of an arteriovenous malformation. Selective angiography revealed an enlarged gastroduodenal artery feeding the malformation and subsequently draining into the portal venous circulation. Embolization of the gastroduodenal artery and of other small branches from the superior mesenteric artery resulted in complete obliteration of the feeding arteries and drainage veins. There was no bleeding recurrence, and the epigastric pain resolved. This case report demonstrates that selective transarterial embolization is a feasible and effective procedure for the treatment of a bleeding pancreatic head arteriovenous malformation.