Severe acute pancreatitis concurrent with lethal rupture of cerebral aneurysm: A case report and review of the literature

Introduction: With high incidence and mortality, severe acute pancreatitis (SAP) is an inflammatory disease of pancreas. When concurrent with systemic inflammatory response syndrome (SIRS), multiple organ failure syndrome (MODS) or pancreatic encephalopathy (PE), it will significantly augment the mortal rate. Herein, we report the first SAP case complicated with fatal rupture of cerebral aneurysm and pre-existing cerebral arteriovenous malformation; meanwhile, numerous examinations indicated the occurrence of SIRS and MODS.

Case presentation: A 34-year-old male was admitted for these complaints of fixed and continuous epigastric distending pain, nausea and vomiting for nearly 6 h after his greasy lunch. Imaging and experimental examinations indicated SAP concurrent with SIRS and MODS in this patient. Conventional therapies stabled him, but he developed unconscious for fatal rupture of cerebral aneurysm based on cerebral magnetic resonance imaging results. Subsequent treatments failed and this patient died from lethal systemic complications.

Discussion: After reviewed relevant literature in detail, we unveil the potential mechanisms in this case that systemic inflammation initiated by necrotic tissues of pancreas will disrupt blood-brain barrier (BBB), increase BBB permeability, trigger neuroinflammation and eventually damage cerebral vascular.

Conclusion: Therefore, to prevent lethal complications of PE or cerebral hemorrhage (CM) in severe pancreatitis, more attentions are recommended to be paid on identifying inflammation-induced brain dysfunction and applying prompt anti-inflammatory therapies.

Keywords: Blood-brain barrier; Case report; Cerebral aneurysm rupture; Inflammation; Severe acute pancreatitis.