Inoue Y, Yata Y, Yokota Y, Li ZL, Kawabata K. Acute pancreatitis after total aortic arch replacement leading to walled-off necrosis: A case report and review of literature. World J Clin Cases 2025; 13(22): 104165 [DOI: 10.12998/wjcc.v13.i22.104165]
Corresponding Author of This Article
Yuma Inoue, MD, Department of Gastroenterology, Hanwa Memorial Hospital, 3-5-8 Minami-sumiyoshi, Sumiyoshi-ku, Osaka 558-0041, Japan. inoueyumainoueyuma@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Acute pancreatitis after total aortic arch replacement leading to walled-off necrosis: A case report and review of literature
Yuma Inoue, Yutaka Yata, Yuta Yokota, Zhao-Liang Li, Kazumi Kawabata
Yuma Inoue, Yutaka Yata, Yuta Yokota, Kazumi Kawabata, Department of Gastroenterology, Hanwa Memorial Hospital, Osaka 558-0041, Japan
Yutaka Yata, Department of Hepatology, Osaka Metropolitan University, Osaka 545-0051, Japan
Zhao-Liang Li, Department of Gastroenterology, Takarazuka City Hospital, Takarazuka 665-0827, Hyōgo, Japan
Co-corresponding authors: Yuma Inoue and Yutaka Yata.
Author contributions: Inoue Y contributed to conceptualization and manuscript writing; Yata Y contributed to manuscript supervision; Inoue Y and Yata Y contributed to manuscript editing, they contributed equally to this article, they are the co-corresponding authors of this manuscript; Inoue Y, Yokota Y, Li ZL, and Kawabata K contributed to data collection; and all authors critically reviewed the manuscript, approved the final version to be published, and agreed to be accountable for all aspects of the work.
Informed consent statement: As a case report, we obtained written informed consent from the patient regarding the treatment method and the use of his clinical data for clinical study purposes.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yuma Inoue, MD, Department of Gastroenterology, Hanwa Memorial Hospital, 3-5-8 Minami-sumiyoshi, Sumiyoshi-ku, Osaka 558-0041, Japan. inoueyumainoueyuma@gmail.com
Received: December 16, 2024 Revised: March 5, 2025 Accepted: April 15, 2025 Published online: August 6, 2025 Processing time: 149 Days and 11.3 Hours
Abstract
BACKGROUND
Although acute pancreatitis and walled-off necrosis (WON) are rare complications following aortic surgery, they are serious risk factors for postoperative mortality. Considering the poor general condition of the postoperative patient, more effective and less invasive treatments are favorable.
CASE SUMMARY
A 67-year-old man was referred to our hospital for the treatment of WON after acute pancreatitis. He had undergone total aortic arch replacement due to aortic arch aneurysm and coronary artery bypass grafting due to angina pectoris 6 weeks prior in another hospital. On the second postoperative day, laboratory data and computed tomography showed that the patient had developed acute pancreatitis. Although conservative management (antibiotics, hydration, etc.) had helped in relieving the symptoms of acute pancreatitis, peripancreatic fluid collection (PFC) persisted, accompanied by duodenal obstruction and vomiting. Contrast-enhanced computed tomography showed that the heterogeneous enhancement and fluid collection in the pancreatic body and tail had increased, consistent with walled-off WON. We therefore performed endoscopic ultrasound-guided transluminal drainage for the PFC. As a result, the WON resolved gradually, resulting in improved oral intake.
CONCLUSION
Acute pancreatitis is a rare gastrointestinal complication following thoracic and thoracoabdominal aortic aneurysm surgery. To the best of our knowledge, this is the first case of WON after aortic arch surgery treated with endoscopic ultrasound-guided transluminal drainage for PFC.
Core Tip: We experienced a 67-year-old man who suffered from walled-off necrosis (WON) after total aortic arch replacement due to aortic arch aneurysm 6 weeks before. After conservative management (antibiotics, hydration, etc.), the WON did not improve but also caused duodenal obstruction and vomiting. We performed endoscopic ultrasound-guided transluminal drainage for the peripancreatic fluid collection. As a result, the WON resolved gradually resulting in improved oral intake. Acute pancreatitis is a rare gastrointestinal complication following thoracic and thoracoabdominal aortic aneurysm surgery. To the best of our knowledge, this is the first case of WON after aortic arch surgery treated with endoscopic ultrasound-guided transluminal drainage.
