[Acute pancreatitis after surgical treatment of abdominal aortic aneurysm].
BACKGROUND
Acute pancreatitis after surgical treatment of non ruptured aneurysm of abdominal aorta is a rare complication, considered to be due to pancreatic ischemia or peroperative trauma of pancreas. The aim of this study is to describe 4 new cases of this complication and to discuss its etiology.


METHODS
From January 1995 to November 2000, 365 patients underwent elective surgery for a non ruptured abdominal aorta aneurysm. Four (1.1%) men, aged 66 to 79 years and operated for an aneurysm which diameter ranged from 60 to 77 mm, developed postoperative acute pancreatitis. The abdominal approach was a midline incision in 3 cases and a retroperitoneal lombotomy in one case. Superior pole of the aneurysm always adjoined or involved the right renal artery. The aortic clamping was supra-renal in 3 cases and celiac in one case. Diagnosis of acute pancreatitis was established at days 2, 4, 12, and 23 after surgery on abdominal computed tomography in 3 cases and at reoperation in one case.


RESULTS
Three patients died, including 2 from early multiple organ failure and one peroperatively during surgical attempt to treat a prostheto-digestive fistula. One patient was alive and asymptomatic with a 2-years follow-up.


CONCLUSIONS
Acute pancreatitis is a rare and serious complication after surgical treatment of abdominal aorta aneurysm. Its diagnosis is often delayed. The main etiological factor of this complication could be trauma of pancreas during supra-renal clamping through a midline incision.
Vibert
E
E
Service de chirurgie vasculaire, hôpital Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
Becquemin
J P
JP
Rotman
N
N
Mellière
D
D
D000208:Acute Disease; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D010195:Pancreatitis / Q000209:etiology* / Q000473:pathology; D011183:Postoperative Complications; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000379:methods