Pseudoaneurisma de aorta abdominal como complicação de pancreatite crônica: relato de caso

Abstract

Chronic pancreatitis can be complicated by several vascular disorders, such as bleeding pseudocysts, thrombosis of the venous portal system, varicosities, and pseudoaneurysms. Pseudoaneurysm of the abdominal aorta secondary to chronic pancreatitis is a rare complication. It is a challenging clinical situation, demanding a high degree of clinical suspicion, and requires complex therapeutic procedures. The pathophysiology of this condition involves interstitial liberation and activation of enzymes from the exocrine pancreatic glands and subsequent digestion of the surrounding tissues. In the present case report, we describe a 52-year-old patient complaining of diffuse abdominal pains. Clinical investigation revealed chronic alcoholism and imaging examinations showed a pseudoaneurysm of the infrarenal aorta. We decided to perform conventional surgical treatment after considering the patient' s age and clinical status and the endoprostheses available at our hospital with diameters compatible with the patient' s aorta.Keywords: pseudoaneurysm; abdominal aorta; pancreatitis. ResumoA pancreatite crônica é uma enfermidade associada a diversas complicações vasculares, como pseudocisto hemorrágico, trombose do sistema venoso portal e formações varicosas e pseudoaneurismáticas. O pseudoaneurisma de aorta abdominal secundário à pancreatite crônica é uma complicação rara, de difícil suspeição clínica, que requer tratamento complexo. A fisiopatologia dessa condição envolve a corrosão enzimática tecidual após a liberação e ativação de enzimas exócrinas proteolíticas das células acinares do pâncreas. O presente estudo relata o caso de um paciente de 52 anos, etilista crônico, internado com dor abdominal difusa, cuja propedêutica revelou se tratar de um pseudoaneurisma em aorta infrarrenal. Optou-se pelo tratamento cirúrgico convencional, levando-se em consideração a idade, as condições clínicas do paciente e a disponibilidade de endopróteses compatíveis com o diâmetro da aorta.Palavras-chave: pseudoaneurisma; aorta abdominal; pancreatite.

Chimney endovascular aortic repair is a viable salvage technique in a paravisceral pseudoaneurysm secondary to acute on chronic pancreatitis

“…Other studies have described pseudoaneurysms of the distal abdominal aorta secondary to pancreatitis, repaired in an open fashion after extra-anatomic bypass grafting or use of straight EVAR and/or iliac grafts. 3,4,9-11 Ch-EVAR have been used in non-pancreatitis related visceral aortic aneurysm ruptures with varied success. 6,7…”

“…1 These can result in catastrophic complications including haemorrhage, erosion of upper gastrointestinal arteries, thrombosis of the portal venous system, formation of pseudoaneurysms including rupture, extra-hepatic biliary obstruction and/or arteriovenous fistulas. 2,3 The pathogenesis of these vascular complications are related to severe pancreatic inflammation and pancreatic necrosis which results in locoregional spread of pancreatic lipolytic and proteolytic enzymes that lead to the damage of vessel walls. The splenic artery is the most commonly effected vessel (40% of cases), followed by the gastroduodenal, pancreaticoduodenal, gastric and hepatic arteries (in order of frequency).…”

“…2,3 Abdominal aortic pseudoaneurysms secondary to pancreatitis are exceedingly rare, with only 4 case reports presented in the literature. 3,4…”

“…The splenic artery is the most commonly effected vessel (40% of cases), followed by the gastroduodenal, pancreaticoduodenal, gastric and hepatic arteries (in order of frequency). 2,3 Abdominal aortic pseudoaneurysms secondary to pancreatitis are exceedingly rare, with only 4 case reports presented in the literature. 3,4 Endovascular aortic repair (EVAR) is well established in the treatment of infrarenal abdominal aortic aneurysms.…”

“…2,3 Abdominal aortic pseudoaneurysms secondary to pancreatitis are exceedingly rare, with only 4 case reports presented in the literature. 3,4 Endovascular aortic repair (EVAR) is well established in the treatment of infrarenal abdominal aortic aneurysms. 5 For juxtarenal aortic disease, fenestrated or branched endografts (FEVAR/BrEVAR) may be used.…”