Background : Pancreatic hemangiomas are a rare cause of pancreatic neoplasms. Definitive diagnosis is difficult as radiological imaging can hardly delineate them from other pancreatic tumours. Pancreatic hemangiomas are mainly managed surgically due to the aforementioned diagnostic uncertainty.

Methods : We present a case of a 45-year old male patient with no significant symptoms and a cystic conglomerate found in front of the abdominal aorta during routine ultrasonography. A contrast-enhanced CT was performed, which showed an irregular lobulated tumor measuring 15cm in diameter, containing fluid material and solid components, located in the head of the pancreas. The other findings were unremarkable.

Results : After the patient`s case was discussed, an elective pylorus-preserving pancreatoduodenectomy (PPPD) was chosen as a treatment option. During the procedure the lesion was found to be tightly adherent to the duodenum and superior mesenteric vein. Intraoperative frozen section pathologic examination showed a cystadenoma. The operation proceeded 280 minutes with blood loss of 50ml. The final pathological examination showed a cavernous pancreatic hemangioma. On the first postoperative day due to acute intraabdominal hemorrhage from the major omentum, a reoperation was performed. On the 11th postoperative day, a percutaneous drainage was placed due to an infrahepatic liquid collection. The patient was discharged on the 17th postoperative day after removal of the percutaneous drainage.

Conclusions : Pancreatic hemangiomas are extremely rare and have no specific clinical symptoms. Current imaging examinations cannot always give conclusion and may be unable to give exact diagnosis. Despite possible postoperative complications, a surgical intervention is demanded.