Computed Tomography Identifies Clinically Unsuspected Acute Necrotizing Pancreatitis Complicating Abdominal Aortic Repair

Abstract

Pancreatitis rarely complicates aortic repair. The aim of the study was to examine the role of imaging in identifying this complication and to characterize pancreatitis occuring in this setting. The radiology information system queried reports for terms pancreatitis, fluid collection, peripancreatic fluid, and aortic/aneurysm/endovascular/open repair from January 2010 through May 2018 and yielded 243 unique patients. Aortic repair and pancreatitis did not occur in temporal proximity (within 30days) in 227 patients, and three patients had invalid medical record numbers. The final population was 13 patients. Surgical data included indication for repair and surgical approach. Clinical/imaging data points included method of diagnosis, type of pancreatitis, location, management of collections, and patient outcome. Thirteen patients (n=9 male, age 58-76years) met inclusion criteria. All patients underwent open repair, 9 electively. Acute pancreatitis was first identified by computed tomography in 10 (77%) patients and by serum lipase levels in 3 patients (23%). Necrotizing pancreatitis was present in 10 patients (77%), eight with infected collections (one not sampled). Four patients (31%) had collections fistulizing to the aortic sac, and there was one case of aortic anastomotic pseudoaneurysm. There were 7 deaths (4 septic shock, 1 hemorrhagic pancreatitis, 1 pulmonary embolism, and 1 multiorgan failure) despite 5 of these patients undergoing drainage of collections. In surviving patients, 4 underwent drainage of collections, 1 necrosectomy, and 1 no intervention. Pancreatitis complicating aortic repair occurs after open repair and is often necrotizing. Pancreatitis is more often first detected by imaging rather than serum lipase levels. High mortality is more attributable to complications of pancreatitis rather than failure of the aortic repair.