Acute pancreatitis after total aortic arch replacement leading to walled-off necrosis: A case report and review of literature

Abstract

BACKGROUND

Although acute pancreatitis and walled-off necrosis (WON) are rare complications following aortic surgery, they are serious risk factors for postoperative mortality. Considering the poor general condition of the postoperative patient, more effective and less invasive treatments are favorable.

CASE SUMMARY

A 67-year-old man was referred to our hospital for the treatment of WON after acute pancreatitis. He had undergone total aortic arch replacement due to aortic arch aneurysm and coronary artery bypass grafting due to angina pectoris 6 weeks prior in another hospital. On the second postoperative day, laboratory data and computed tomography showed that the patient had developed acute pancreatitis. Although conservative management (antibiotics, hydration, etc.) had helped in relieving the symptoms of acute pancreatitis, peripancreatic fluid collection (PFC) persisted, accompanied by duodenal obstruction and vomiting. Contrast-enhanced computed tomography showed that the heterogeneous enhancement and fluid collection in the pancreatic body and tail had increased, consistent with walled-off WON. We therefore performed endoscopic ultrasound-guided transluminal drainage for the PFC. As a result, the WON resolved gradually, resulting in improved oral intake.

CONCLUSION

Acute pancreatitis is a rare gastrointestinal complication following thoracic and thoracoabdominal aortic aneurysm surgery. To the best of our knowledge, this is the first case of WON after aortic arch surgery treated with endoscopic ultrasound-guided transluminal drainage for PFC.

Keywords: Aortic arch replacement; Endoscopic ultrasound-guided drainage; Peripancreatic fluid collection; Walled-off necrosis; Case report

Core Tip: We experienced a 67-year-old man who suffered from walled-off necrosis (WON) after total aortic arch replacement due to aortic arch aneurysm 6 weeks before. After conservative management (antibiotics, hydration, etc.), the WON did not improve but also caused duodenal obstruction and vomiting. We performed endoscopic ultrasound-guided transluminal drainage for the peripancreatic fluid collection. As a result, the WON resolved gradually resulting in improved oral intake. Acute pancreatitis is a rare gastrointestinal complication following thoracic and thoracoabdominal aortic aneurysm surgery. To the best of our knowledge, this is the first case of WON after aortic arch surgery treated with endoscopic ultrasound-guided transluminal drainage.