Abdominal angina due to recurrence of cancer of the papilla of Vater: a case report

• Published in: Journal of medical case reports 2009-12, Vol.3 (1), p.9314-9314, Article 9314
• Main Authors: Biolato, Marco, Gabrieli, Maria Letizia, Parente, Antonello, Racco, Simona, Costantini, Melania, Bonomo, Lorenzo, Rapaccini, Gian Ludovico, Gasbarrini, Giovanni, Grieco, Antonio
• Format: Article
• Language: English
• Subjects: Abdominal pain; Adenocarcinoma; Care and treatment; Case report; Case studies; Complications and side effects; Diagnosis; Risk factors
• ISSN: 1752-1947; 1752-1947
• DOI: 10.1186/1752-1947-3-9314

Abdominal angina is usually caused by atherosclerotic disease, and other causes are considered uncommon. This is the first report of a case of abdominal angina secondary to neoplastic vascular stenosis caused by local recurrence of an adenocarcinoma of the papilla of Vater. An 80-year-old woman of Caucasian origin presented with abdominal pain and diarrhea. She had undergone a pancreaticoduodenectomy for adenocarcinoma of the papilla of Vater four years earlier. Computed tomography revealed a mass surrounding her celiac trunk and superior mesenteric artery. Her abdominal pain responded poorly to analgesic drugs, but disappeared when oral feedings were withheld. A duplex ultrasonography of the patient's splanchnic vessels was consistent with vascular stenosis. Parenteral nutrition was started and the patient remained pain free until her death. Pain relief is an important therapeutic target in patients with cancer. In this case, abdominal pain was successfully managed only after the ischemic cause had been identified. The conventional analgesic therapy algorithm based on nonsteroidal anti-inflammatory drugs and opioids had been costly and pointless, whereas the simple withdrawal of oral feeding spared the patient of the discomfort of additional invasive procedures and allowed her to spend her remaining days in a completely pain-free state.