Gastrointestinal Pathology - Case 7 - Part 3
   

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CT scans done on 4-18-02 demonstrated progression of the cancer with soft tissue masses in the region of the pancreatic bed and a liver metastasis. Old clips from the surgery are seen.

 
 
On 12-14-02 a CT scan found that tumor was impinging on the superior mesenteric artery and invading the portal vein. Additionally there were three sites of metastatic disease in the liver.
Tail of pancreas and vasculature
Liver mass
Clips in the bed ot the pancreatic head
View of superior mesenteric artery
Despite chemotherapy for 2 years the lesions were progressing and the family declined further treatment and requested only comfort measures. He continued to bleed per rectum.

1. What do you think is the cause of bleeding?