S3468 Severe Acute Pancreatitis With Abdominal Compartment Syndrome, Colonic Necrosis, and Splenic Artery Aneurysm Rupture: A Case of Multi-Organ Failure Requiring Multidisciplinary Management

Introduction: Acute pancreatitis can lead to multi-organ dysfunction and significant morbidity. We present a case of a 63-year-old man with severe pancreatitis complicated by acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), septic shock, abdominal compartment syndrome, and vascular catastrophes. Case Description/Methods: A 63-year-old man with medical history presented with acute severe mid-epigastric pain radiating to the back, accompanied by nausea and vomiting. Laboratory results revealed elevated lipase levels (>5000 U/L) and leukocytosis. Imaging did not show gallstones, and liver function tests were normal, making biliary etiology less likely. Admitted to a general medical floor, the patient's condition deteriorated with respiratory failure and abdominal distension, prompting consultations with critical care and general surgery. Despite non-invasive respiratory support, he required intubation and mechanical ventilation. Bladder pressures were elevated, indicating abdominal compartment syndrome, while worsening lactic acidosis and leukocytosis suggested systemic inflammatory response and shock. An emergent exploratory laparotomy revealed colonic necrosis, necessitating subtotal colectomy and open abdomen management with staged abdominal washouts. A diverting loop ileostomy was created, and additional procedures included cholecystectomy and abdominal wall closure. Complications included right-sided pneumothorax requiring chest tube placement, acute blood loss anemia, and persistent intra-abdominal sepsis. Gastrointestinal hemorrhage was managed with interventional radiology-guided coil embolization of a gastroduodenal artery branch and splenic artery aneurysm. Through a multidisciplinary approach, the patient’s hemodynamic and mental status improved. Discussion: This case highlights the complex nature of severe acute pancreatitis and its potential for life-threatening complications. The development of abdominal compartment syndrome was a key challenge, requiring urgent surgical decompression. The interplay between pancreatitis, septic shock, and multi-organ failure underscores the importance of early recognition and intervention. The role of interventional radiology was pivotal, particularly in managing gastrointestinal hemorrhage and addressing vascular complications like the splenic artery aneurysm. This case reinforces the value of a coordinated, multidisciplinary approach, emphasizing the need for continuous monitoring and timely interventions.