Male Patient with Acute Abdomen

Friday, July 29, 2011
A 60-year-old male who was being treated for acute-on-chronic pancreatitis with a large pancreatic-pseudocyst presented with acute abdomen to the emergency department. On presentation he was hypotensive. Laboratory parameters confirmed low haemoglobin (8.6 gm/dl) and mildly elevated serum amylase levels (180IU). Serum electrolytes revealed a low sodium and pottasium.Contrast CT abdomen was performed and two images were given below.
Axial CECT abdomen

Coronal CECT abdomen
What is the diagnosis? 

ANSWER

Contrast CT abdomen revealed atrophic and papery-thin body-tail of pancreas with relatively spared pancreatic-head. Adjacent peripancreatic fat planes were dirty. No overt fluid collection was seen in its vicinity. Additionally, a giant aneurysmal sac from the right postero-lateral aspect of the abdominal aorta at L1-L2 vertebral level was seen.The sac was seen extending into the right paravertebral gutter with extension also seen into the right psoas sheath.

Giant aortic pseudoaneurysm
Pseudoaneurysm formation is a recognised but relatively uncommon complication associated with pancreatitis. The most common artery affected is the splenic artery, followed by gastroduodenal, pancreaticodudenal, left gastric, hepatic and small intrapancreatic arteries in decreasing order of frequency. The probable aetiopathogenesis suggests that the release of proteolytic pancreatic enzymes (especially trypsin and elastase) into the perivascular space results in enzymatic digestion and weakening of the arterial wall. The damaged vessel wall under the influence of sustained arterial pressure leads to dissection of blood into the perivascular tissues forming a perfused sac that communicates with the arterial lumen.

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5 comments

  1. Anonymous Says:
  2. paralytic ileus due to electrolyte disturbance(hypokalemi, hyponatremia)paralytic ileus due to electrolyte disturbance(hypokalemi, hyponatremia)

     
  3. Anonymous Says:
  4. ruptered pseudo-pancreatic cyst

     
  5. Anonymous Says:
  6. hemorrhage into the cyst

     
  7. Fistula developed between Aorta and the pseudocyst

     
  8. al shabahi Says:
  9. i think, pseudocystoaortic fistula

     

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