AAD is an important disease, although it is rare, which may lead to several complications according to localizations involved. Complications often occur randomly, and the outcome is often fatal
5. Some complications such as myocardial infarction, stroke and hemiparesis were reported previously in the literature
6-8. To our knowledge, acute pancreatitis as a form of presentation of AAD is unusual. Pombo et al and Goff et al reported a case of pancreatitis following AAD
9,10. Our case is the third report, in which AP is secondary to acute AAD.
Generally, acute pancreatitis (AP) may occur in the postoperative period of various surgical procedures such as abdominal aortic aneurysm repair, and cardiac surgery11,12. In these cases, systemic and regional hypoperfusion, atheromatous emboli to arteries supplying the pancreas, and direct trauma to the pancreas during the operation from surgical dissection have been distinguished in the causes of acute pancreatitis. Similarly, AAD induced acute pancreatitis may be associated with ischemia. We believe that in our patient, an ischemia secondary to hypoperfusion may be responsible for the AP.
Elevated serum amylase and/or lipase, particularly when their serum levels are more than three times of normal, are diagnostic for acute pancreatitis13.
The increased serum levels of these enzymes may be related to an ischemic pancreatic disease. Thus, in the absence of any pancreatic disease, increased enzyme levels may point to aortic dissection.
As mentioned above, the probable pathological mechanism is ischemia of pancreas as a result of obstruction of arterials supplying the pancreas. When there is ischemia in the pancreas, amylase and lipase enter the bloodstream directly or via the lymphatic. In result, serum amylase and lipase levels rise and contribute to the biochemical diagnosis of acute pancreatitis14.
In summary, acute pancreatitis following acute aortic dissections is uncommon, but its true incidence may be higher than those reported here. The diagnosis of aortic dissection should be considered in a patient presenting with unexplained gastrointestinal symptoms, especially those associated with acute pancreatitis.