Acute pancreatitis complicated by rupture of abdominal aortic aneurysm

Acute pancreatitis (AP) is a potentially life-threatening inflammatory disease with wide ranging severity and unpredictable evolution [1]. Extremely rarely AP co-exists with abdominal aortic aneurysm (AAA). It is estimated that, among gastroenterological complications associated with ruptured abdominal aortic an-eurysm (rAAA), AP occurs in 0.7% and significantly increases the mortality rate [2]. However, rupture of AAA caused by elevated pancreatic enzymes concentrations has not been previously described. This case is the first documenting rAAA in the course of severe AP. We present a case of severe AP complicated by rupture of AAA, which was treated by open abdomen (OA) with application of negative pressure wound therapy (NPWT). A 65-year-old patient was admitted to the surgical ward because of severe pain in the upper abdomen with nausea and vomiting without relief for 10 h. Laboratory tests revealed the following: elevated serum amy-lase, serum lipase, C-reactive protein (CRP), white blood cell count, and serum glucose. Ultrasound examination demonstrated the presence of AAA localised below the renal arteries, measuring 7 × 5 cm, without evidence of rupture. A diagnosis of AP was made. On admission, the severity of AP on the Ranson scale was assessed as 3. Conservative therapy was initiated. During the fourth day of hospitalisation, the patient's condition deteriorated , epigastric pain had intensified, and clinical symptoms of the hypovolemic shock occurred. Computed to-mography (CT) confirmed raptured rAAA. According to APACHE II scale the severity of AP was classified on 14 scores (severe AP). Computed tomog-raphy angiography (angio-CT) indicated rAAA with dimensions 8 × 5.8 cm (Figure 1). Pancreatic parenchy-ma was assessed according to CTSI index on 2 points. None of acute peripancreatic fluid collections (APFC) were identified. Emergency surgery of the rAAA was performed. During the operation a linear 1.5-cm rupture of the infrarenal AAA sac was indicated. In place of the rAAA a simple aortic prosthesis was sutured (length of prosthesis 80 mm, Cook). About 1800 ml of blood was sucked from the abdominal cavity. Immediately after surgery an ABThera dressing (KCI company, San Anto-nio, USA) was applied (Figures 2, 3). The duration of NPWT was 30 h, and the dressing was changed two times (respectively, after 10 and 20 h). A negative pressure of 125 mm Hg was applied in continuous mode. Up to the time of the first dressing change 350 ml of fluid was resorbed from the abdominal cavity, and up to the second dressing exchange it …