Acute Ischemic Pancreatitis Associated with Acute Type B Aortic Dissection: A Case Report

Abstract

A 47 year-old man, presenting with sudden back pain in the absence of abdominal discomfort, was diagnosed with acute type B aortic dissection which extended to the celiac and the splenic arteries. Antihypertensive treatment was initiated. However, he subsequently complained of upper abdominal pain with increased amylase levels. Computed tomography scan (CT) revealed new accumulation of peripancreatic fluid with no signs of further aortic or visceral dissection. A protease inhibitor was administered for mild acute pancreatitis. Follow-up CT demonstrated disappearance of thrombosed false lumen of the splenic artery and reduction of the effusion. The patient was discharged without any surgical interventions.

Aortic Dissection Presenting as Acute Pancreatitis: Suspecting the Unexpected

“…The patient developed upper abdominal pain as well as an elevation in pancreatic amylase. A CT showed peripancreatic fluid [ 8 ]. These findings were consistent with acute pancreatitis.…”

Acute Pancreatitis Induced by Acute Type A Aortic Dissection: A Case Report

“…2 However, it is uncommon for an acute AD to cause AP, and only a few case studies have reported this association. [4][5][6] AD can affect the visceral arterial blood flow to the pancreas, causing ischemic pancreatitis and releasing lipase as a stress enzyme. 6 Another pathophysiology was described by Hamamoto.…”

Ischemic Acute Pancreatitis Associated with Abdominal Aortic Aneurysm

“…Although the incidence of ischemic AP is rare, it has been reported in various clinical situations, such as atheromatous embolization, aortic dissection, hemorrhagic shock, intraoperative hypotension and aortic surgery, and pancreatic transplantation. [8][9][10][11][12][13][14][15][16] The pathogenesis of ischemic pancreatitis is associated with parenchymal hypoperfusion of the pancreas. Hence, any conditions that can aggravate the blood supply would be risk factors for ischemic pancreatitis, such as advanced age, diabetes mellitus, vascular disease, smoking, diminished cardiac function, and emergent cardiac surgery.…”

“…18 In this case, the patient may be predisposed to vascular hypoperfusion because of the underlying severe atherosclerotic changes on the root of the celiac trunk and SMA. 15,19 Therefore, it is speculated that the newly developed AAA would have evoked the sudden deterioration of the pancreatic circulation, leading to the AP.…”