S1937 Acute Pancreatitis Due to Vascular Insufficiency From Celiac Artery Stenosis

Abstract

Introduction: Acute pancreatitis is a leading cause of hospitalizations in the United States. The pancreas relies on blood supply from the celiac and superior mesenteric arteries. Compromise to any part of the pancreatic circulation may lead to inflammation. Vascular insufficiencies are an uncommon cause of acute pancreatitis. We present a rare case of acute pancreatitis secondary to celiac stenosis with concomitant abdominal aortic aneurysm thrombosis. Case Description/Methods: The patient is a 79-year-old female with history of tobacco use and peripheral vascular disease that presented for one day of abdominal pain. She noted nausea with non-bloody emesis during this time. Labs revealed a leukocytosis with WBC 17.1, lactate 2.7, AST 25, ALT 16, alkaline phosphatase 53, Total bilirubin 0.8, direct bilirubin 0.1, and a lipase of 976. A CTA of the abdomen was demonstrated inflammatory fluid with pancreatic tail necrosis, peripancreatic stranding, stenosis of the celiac origin and thrombosed aortic aneurysm measuring 6.1cm with distal reconstitution. She was placed on intravenous heparin and lactated ringer infusions. After the diagnosis of her acute pancreatitis, she was found to have a normal triglyceride level and IgG4 level. An abdominal ultrasound revealed gallbladder sludge without cholelithiasis or biliary dilation. There was no history of alcohol use preceding her hospitalization. Moreover, there were no new medications or over the counter supplements reported. It was felt the patient’s pancreatitis was a result of arterial insufficiency from celiac artery stenosis. The patient was seen by vascular surgery and was treated medically. During her stay she developed worsening pleural effusion and hypoxic respiratory failure requiring oxygen. She was ultimately discharged to a skilled nursing facility when medically stable (Figure). Discussion: Isolated case reports of acute pancreatitis due to vascular insufficiencies have been reported without defined incidence or prevalence. The head of the pancreas receives blood supply from the celiac trunk and superior mesenteric artery respectively. The body and tail of the pancreas are more vulnerable to ischemia, being perfused solely by the splenic artery. After ruling out common etiologies, compromise of the celiac artery was presumed to be the cause of this patient’s disease process. Conservative treatment yielded satisfactory results in our case, however the standard of care regarding acute pancreatitis with vascular insufficiencies need additional elucidation.Figure 1.: A. Celiac artery stenosis. B. Pancreatitis with pancreatic tail necrosis and peripancreatic fluid and stranding. C. Thrombosis within distal aorta.