Ischemic acute pancreatitis with pancreatic pseudocyst in a patient with abdominal aortic aneurysm and generalized atheromatosis – case report

Abstract

BackgroundIschemic pancreatitis is a rare medical entity. The pancreatic tissue is susceptible to ischemia with the possibility of developing acute pancreatitis. The abdominal aortic aneurysm can be one possible cause of pancreatic hypoperfusion.Case presentationWe report the case of a 68-year-old man, Caucasian, with a history of a cluster of severe cardiovascular conditions, who presented epigastric pain of variable intensity for about 2 weeks. The pain occurred after intense physical effort, and was associated with anorexia and asthenia. The palpation revealed epigastric pain and palpable pulsatile mass above the umbilicus. Laboratory tests showed increased serum and urine amylases. The abdominal contrast-enhanced CT scan evidenced acute lesions of the pancreas and a caudal pancreatic pseudocyst of 39x24 mm. An abdominal aortic aneurysm was also described (which extended from the kidney level to the bilateral femoral level) with a maximum diameter of 60.5 mm and generalized atheromatosis. By corroborating clinical, anamnestic, laboratory and imaging data, the case was diagnosed as moderately severe acute ischemic pancreatitis, pancreatic pseudocyst, abdominal aortic aneurysm, generalized atheromatosis. The pancreatic pseudocyst was resorbed in eight months. Surgery for the abdominal aneurysm was performed after the resorption of the pseudocyst. The patient died after aortic surgery because of a septic complication.ConclusionIschemic pancreatitis is a rare condition but should be considered in a patient with upper abdominal pain and elevated amylase in the context of an abdominal aortic aneurysm and generalized atheromatosis.

Abdominal aortic aneurysm in the setting ofClostridium perfringenspancreatitis

“…It has previously been hypothesised that AAAs, through occlusion of aortic branches may lead to pancreatic hypoperfusion and consequently to ischaemia and subsequent pancreatitis. Cocota et al reported a case of acute pancreatitis in association with an aneurysm and hypothesised that a combination of a thrombosed aneurysm, generalised atheromatous disease and intense physical activity prior to presentation lead to the development of acute pancreatitis 11. This is a plausible explanation in our case given the large aneurysm and extensive atherosclerosis present.…”

Ischemic Pancreatitis Is an Important Cause of Acute Pancreatitis in the Intensive Care Unit

“…Patients developing IP have been reported in cases with clinically significant AP and have shown convincingly that this is one of the known causes of AP 5–17. The only case series previously describing IP consisted of 11 patients from a tertiary referral center in Germany 5.…”

“…Ischemic pancreatitis (IP) is a poorly defined clinical condition and there is no consensus on diagnostic criteria. Most of the literature on IP is based on case reports with a large variety of causes of IP 3–17. The largest study published to date is a study of patients with IP from a surgical department in Germany with 11 patients with IP of different underlying conditions 5.…”

Is Prior Aspirin Use Associated with Reduced Severity in Patients with Acute Pancreatitis?

“…Hypertension [17], cardiovascular disease [17,18], and diabetes [19,20] have been independently associated with the incidence of AP. Indeed, a higher number of the comorbid disease has been shown to associate with poorer outcomes in AP, including the length of hospitalisation and mortality [21].…”