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Objective: Rapidly growing aneurysms often represent a diagnostic dilemma and can be difficult to treat due to questions of possible infectious etiology. We present a case of an 83-year-old female with a rapidly enlarging abdominal aortic aneurysm of suspected inflammatory or infectious etiology in the setting of gallstone pancreatitis.
Methods: Case report and brief review of the literature
Results: An 83-year-old female with a recent colectomy, presented with severe gallstone pancreatitis and CT findings of a rapidly enlarging, inflamed infra-renal aortic aneurysm. The aneurysm increased from 1.5 cm (figure 1A) to 3.4 cm over the period of one month and a repeat study performed two days later showed an increase to 4.1 cm (figure 1B). An EVAR was performed due to the patient’s high risk of operative repair due to her medical co-morbidities. Follow-up CT one month later revealed near complete shrinkage of the aneurysm sac (figure 1C).
Conclusions: The treatment of rapidly growing aortic aneurysms remains a challenging issue, particularly because of the possibility of infectious etiology of these types of aneurysms. Rapid growth of AAA associated with pancreatitis may be related to hyper-amylasemia, release of other proteolytic enzymes, or possible infectious etiology and is not well described in the literature. EVAR represents a promising treatment modality in these patients as it spares critically ill patients the significant risk of open AAA repair. Our case report demonstrates a very favorable outcome of such a rapidly growing AAA in a high-risk patient with pancreatitis with complete resolution of the aneurysm.