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Query: UMLS:C0162871 (abdominal aortic aneurysm)
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This paper reports three cases of acute pancreatitis that occurred after repair of an abdominal aortic aneurysm. The aneurysms were ruptured in two patients and asymptomatic in one. No patient had biliary disease or history of pancreatitis or alcohol abuse. Two of the patients required operation for drainage and debridement; one died. The etiology and diagnosis are discussed.
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PMID:Acute pancreatitis following aortic aneurysm repair: report of three cases. 187 95

1. Evidence suggests that activation of phospholipase A2 and production of eicosanoids and platelet-activating factor (PAF) are involved in various responses associated with severe tissue damage and shock. It was postulated that the plasma level of the precursor and degradation product of PAF, lyso-platelet-activating factor (lyso-PAF), might be increased in acute severe illness. 2. After plasma extraction, lyso-PAF was acetylated in vitro to PAF, which was measured by bioassay using 5-[14C]hydroxytryptamine-labelled rabbit platelets. Measurements were made in 18 severely ill patients (five with cardiogenic shock; five with severe infection, five after repair of abdominal aortic aneurysm, two with acute pancreatitis; 13 males, five females). Plasma lyso-PAF in these patients was 33 +/- 15 (SD)ng/ml (range 5-111 ng/ml), whereas values in normal males (40-65 years) ranged from 102 to 253 ng/ml (n = 15) and in females from 74 to 174 ng/ml (n = 10). Depression of plasma lyso-PAF did not relate closely to the patient group nor to specific therapy, but repeated measurements in each of 10 patients showed an increase in plasma lyso-PAF (P less than 0.002), associated with clinical improvement. 3. Evidence was obtained indicating that neither the presence of an inhibitor in the assay system nor reconversion of PAF to lyso-PAF in vitro produced the unexpected depression of plasma lyso-PAF. 4. The mechanisms responsible, which may have therapeutic implications, remain to be elucidated.
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PMID:Plasma levels of the lyso-derivative of platelet-activating factor in acute severe systemic illness. 258 28

To understand the surgical approach to acute abdominal pain, the internist must be familiar with common presentations of most abdominal emergencies; these emergencies include acute appendicitis, acute gall bladder disease (biliary colic, acute cholecystitis, and acute pancreatitis), ischemic bowel disease and ischemic colitis, abdominal aortic aneurysm, and intestinal obstruction. Nothing compares to experience; this article reviews the salient points that deserve consideration.
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PMID:An internist's approach to acute abdominal pain. 837 23

Acute pancreatitis (AP) after aortic surgery has rarely been reported. A retrospective review of all abdominal and thoracoabdominal aortic operations complicated with AP from January 1982 to March 1992 was performed to study the presentation and outcome of this infrequently recognized complication. Thirteen cases of AP were found among 1965 abdominal aortic operations (0.7% incidence). The distribution of the original aortic operations was as follows: eight elective abdominal aortic aneurysm repairs, two aortoiliac grafts for aortoiliac occlusive disease, and three aortorenal bypasses. Two cases of pancreatitis complicated 170 thoracoabdominal aortic operations (1.2% incidence). Ten patients had mild pancreatitis, nine were discharged without any pancreatic complications after receiving supportive treatment. Five patients with severe AP died of multisystem organ failure despite aggressive surgical treatment; 4 had infected necrosis. The overall mortality was 40 per cent; severe AP resulted in a 100 per cent mortality. The diagnosis of severe AP was usually made in the second postoperative week, significantly later (P < 0.01) than for patients with mild disease. Typically, patients with mild AP presented with hyperamylasemia at a median of 5 postoperative days, and severe AP was found at reoperation or autopsy after a period of unexplained sepsis. Five patients with mild AP were found to have biliary tract stones, with one requiring endoscopic stone extraction. In conclusion, pancreatitis is an uncommon, although perhaps underreported complication. Underreporting may be due to a lack of hyperamylasemia when severe pancreatitis is diagnosed. The severe form is diagnosed late in patients with postoperative sepsis, associated with infected necrosis, and lethal. The complication may be reduced by incidental cholecystectomy for cholelithiasis.
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PMID:Acute pancreatitis after aortic surgery. 1023 Dec 9

An aged male with a known history of abdominal aortic aneurysm suffered from epigastralgia, vomiting and cold sweating for one day. According to the physical examination, serum amylase level and computed tomographic examination, acute pancreatitis was diagnosed. Surgical intervention for the abdominal aortic aneurysm was not performed because of his age, and finally this patient died after three recurrent episodes. Acute pancreatitis co-existing with an intact abdominal aortic aneurysm has never been reported before. The possible pathogenesis of this recurrent acute pancreatitis was discussed.
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PMID:Abdominal aortic aneurysm compression is probably responsible for the recurrent episodes of acute pancreatitis: case report. 1052 53

A case of acute pancreatitis following resection of a juxtarenal abdominal aortic aneurysm is reported. The patient was a 73 year old man who underwent resection of a juxtarenal abdominal aortic aneurysm. The aneurysm was repaired with a 20 mm. gelatin coated Dacron graft. Proximal control of the aneurysm was performed with supraceliac aortic cross clamping. The clamping time was 50 minutes. Postoperatively, he developed progressive abdominal distension with deterioration of renal and pulmonary function necessitating relaparotomy on the 7th postoperative day. The second operation revealed evidence of saponification and fat necrosis in the omentum. The pancreas was edematous and swollen compatible with acute pancreatitis. The aortic graft and other intraabdominal organs appeared normal. Despite intensive supportive care, the patient died 2 weeks later from multiple system organ failure. The possible causes of acute pancreatitis following aortic surgery described in the literature are 1. systemic and regional hypoperfusion, 2. atheromatous emboli to arteries supplying the pancreas and 3. direct trauma to the pancreas during the operation from retractors or surgical dissection. All of which may be the etiology of acute pancreatitis in our patient. Avoidance of such factors during aortic surgery is recommended to prevent this potentially fatal complication.
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PMID:Acute pancreatitis following resection of juxtarenal abdominal aortic aneurysm. 1065 72

We experienced two cases of rupture of an abdominal aortic aneurysm during the early postoperative period of coronary artery bypass grafting (CABG). A 71-year-old man on hemodialysis (HD) was diagnosed with ischemic heart disease (IHD) and abdominal aortic aneurysm (AAA) of 70 mm in size. After CABG, he developed symptoms of acute pancreatitis and died of rupture of AAA on the 12th postoperative day. A 74-year-old man with early gastric cancer was diagnosed with IHD and AAA of 70 mm. After CABG and gastrectomy, he died of rupture of AAA due to anticoagulant therapy on the 3rd postoperative day. One-stage operation should be performed in patients with IHD, AAA more than 60 mm in size and other organ disease. It is important to control blood pressure and anticoagulant therapy appropriately during the early postoperative period when graft replacement for AAA is not performed simultaneously. Careful observation is required to establish the differential diagnosis of acute pancreatitis and impending rupture of AAA in patients on HD.
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PMID:[Postoperative rupture of abdominal aortic aneurysm in patients with ischemic heart disease and other organ disease]. 1135 98

Acute pancreatitis, leaking abdominal aortic aneurysm, and renal trauma frequently occur in the setting of patients with abdominal nontraumatic and traumatic injury; it represents the most urgent conditions that may determine the presence of fluid collections or haematoma in the retroperitoneum. Single spiral CT and multidetector-row CT (MDCT) play an important role in diagnosis of retroperitoneal emergencies, providing useful informations on the type, site, extent and management of the fluid collections. An accurate CT assessment requires the awareness of the existence of dissectable retroperitoneal fascial planes. Fluid collections or haematoma tends to escape the retroperitoneal site of origin into planes extend from the diaphragm to the pelvic floor. We assess the multicompartimental anatomy of the retroperitoneum and the pathway of spread of the most frequent retroperitoneal fluid collections or haematoma by helical CT.
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PMID:Emergencies in the retroperitoneum: assessment of spread of disease by helical CT. 1509 38

We report a case of acute necrotizing pancreatitis after extraperitoneal repair of an abdominal aortic aneurysm (AAA). Acute pancreatitis (AP) is an uncommon complication of vascular surgery; however, managing its local and general consequences, including the eventual pancreatic abscess and the risk of prosthetic infection, presents formidable challenges.
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PMID:Infected pancreatic necrosis after extraperitoneal abdominal aortic aneurysm repair: report of a case. 1851 40

Endovascular treatment of thoracic and thoraco-abdominal aortic aneurysm with celiac artery ostium coverage, seems to be safe according to the literature. We present a case in which the endograft deployement was achieved through a right common carotid artery access because four years before the patient was submitted to an axillo-bifemoral bypass with aortic graft removal and aortic stump ligature for infection. After endovascular repair the patient suffered from spinal cord ischemia, acute pancreatitis and spleen infarction. Probably, the new pancreatic event has been triggered by temporary visceral ischemia, acting on a pancreas damaged by a previous acute hemorrhagic pancreatitis.
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PMID:Transcarotideal access for endovascular repair of descending thoracic aortic aneurysm with intentional coverage of celiac artery. 1916 6


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