A Case report of pancreatectomy preserving the middle portion of the pancreas for arteriovenous malformation of pancreatic head and tail

A 57-year-old man visited a local hospital with abdominal pain and was found to have elevated liver and biliary tract enzymes. Endoscopic sphincterotomy was done under suspicion of choledocholithiasis. Then he presented progressive anemia due to hemobilia, and he was referred to our hospital after emergency embolization of the posterior superior pancreaticoduodenal artery. Arteriovenous malformation (AVM) in both the head and tail of the pancreas was diagnosed and we performed pancreatectomy preserving the middle portion of the pancreas as a function preserving procedure. Subtotal stomach-preserving pancreatoduodenectomy and distal pancreatectomy with splenectomy were performed. A modified Child method and distal end-to-side pancreatojejunostomy was selected for reconstruction. Though he had a Grade B postoperative pancreatic fistula that required percutaneous drainage, he recovered without occurrence of diabetes or any recurrence 2 years after surgery. AVM of the pancreas is regarded as congenital anomaly and frequently has multiple feeding arteries, thus resection can be radical and effective treatment. Though technically demanding, resection preserving the middle portion of the pancreas can be an alternative to total pancreatectomy for patients with multifocal lesion in order to preserving pancreatic endocrine and exocrine functions.