SEVERE ACUTE PANCREATITIS REVEALING EXTENSIVE AORTIC DISSECTION: A CASE REPORT AND LITERATURE REVIEW

Abstract

Severe acute pancreatitis is a frequent reason for hospitalization in the intensive care unit. Biliary and alcoholic etiologies are the most frequent. Vascular etiology, particularly ischemic etiology, is rare. Its often-serious consequences raise the question of how to proceed: should surgical treatment be provided, or should medical care be delayed? This study reports the case of an 87-year-old patient, known to be hypertensive, admitted to the emergency department of the Oued Eddahab military hospital with excruciating epigastric abdominal pain. Investigations revealed severe acute pancreatitis of ischemic origin following thoracoabdominal aortic dissection extending to the superior mesenteric artery. A review of the literature revealed only 15 similar cases of acute pancreatitis of ischemic origin associated with aortic dissection. This underlines the rarity of this situation, and the absence of standardized recommendations for the management of this exceptional situation, which presents the clinician with the dilemma of whether to opt for surgical or medical management. This case demonstrated the exceptional role of medical imaging in the context of severe acute pancreatitis, in terms of diagnosis, prognosis and etiology. It also highlighted the importance of an individualized approach based on multidisciplinary consultation, given the absence of recommendations and the paucity of literature.