Acute occlusion of the ductus pancreaticus due to abdominal aortic aneurysm: Uncommon cause of silent severe acute pancreatitis - a case report and review of the literature

Abstract

We report an uncommon case of severe silent acute pancreatitis (SSAP) caused by compression of the Ductuspancreaticus due to an abdominal aortic aneurysm (AAA) of 79 mm × 59 mm external diameter. A 78-year-old patient with knowncutaneous progressive T-cell lymphoma and hypertension was referred to our institution in August 2013. During hospitalisationthe patient became somnolent and developed elevated infection parameters. Abdominal ultrasonography showed a pulsatingabdominal mass and CT examination revealed a stretched pancreas and an underlying partial thrombosed juxtarenal AAAextending distally to the origin of the superior mesenteric artery (SMA) and the aortic bifurcation without signs of visceralmalperfusion elsewhere. The Ductus pancreaticus was dilated without involvement of the head. There were no additionalradiological findings of occupying character other than the AAA. Because of his advanced age, increasing inflammatoryparameters, and cutaneous T-cell lymphoma the patient was at this point neither suitable for open AAA surgery nor endovasculartreatment. His clinical condition worsened due to development of a systemic inflammatory response syndrome (SIRS) andresulted in death. The presented case demonstrates that a growing