title: Abdominal angina due to recurrence of cancer of the papilla of Vater: a case report.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Internal Medicine, Catholic University of Rome, 8 Largo A Gemelli, 00168 Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Biolato
authors.forename: Maria Letizia
authors.initials: ML
authors.lastname: Gabrieli
authors.forename: Antonello
authors.initials: A
authors.lastname: Parente
authors.forename: Simona
authors.initials: S
authors.lastname: Racco
authors.forename: Melania
authors.initials: M
authors.lastname: Costantini
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Bonomo
authors.forename: Gian Ludovico
authors.initials: GL
authors.lastname: Rapaccini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gasbarrini
authors.forename: Antonio
authors.initials: A
authors.lastname: Grieco