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A case of severe acute pancreatitis and ischemic gastropathy caused by acute aortic dissection

Ikumi Umeda1, Tsuyoshi Hayashi, Hirotoshi Ishiwatari

  • 1Fourth Department of Internal Medicine, Sapporo Medical University.

Nihon Shokakibyo Gakkai Zasshi = the Japanese Journal of Gastro-Enterology
|January 8, 2011
PubMed

Insights

Aortic dissection can lead to severe acute pancreatitis and ischemic gastropathy due to compromised blood flow to the pancreas and stomach. This case highlights a rare complication involving a fistula forming between pancreatic necrosis and the stomach.

Area of Science:

  • Cardiovascular Medicine
  • Gastroenterology
  • Surgical Complications

Background:

  • Aortic dissection is a serious condition involving a tear in the aorta's inner layer.
  • Computed tomography (CT) is crucial for diagnosing aortic dissection.
  • Vascular compromise can lead to ischemic complications in adjacent organs.

Observation:

  • A 49-year-old male presented with chest pain, diagnosed with aortic dissection via CT.
  • Dissection extended to the celiac artery origin, causing hypoperfusion of the pancreas and stomach.
  • The patient developed severe acute pancreatitis and a gastric ulcer (ischemic gastropathy).

Findings:

  • A fistula formed between infected pancreatic necrosis and the stomach.
  • Necrotic pancreatic tissue drained into the stomach.
  • Endoscopy revealed a near-circumferential gastric cardia ulcer.

Implications:

  • This case illustrates a rare, severe complication of aortic dissection impacting the gastrointestinal tract.
  • Early recognition of ischemic complications is vital for managing patients with aortic dissection.
  • Multidisciplinary management may be required for complex cases involving vascular and gastrointestinal compromise.

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