Acute pancreatitis (AP) is a rare complication in the post-operative period and the incidence following colorectal surgery is unknown. Although benign hyperamylasaemia following colonic resection is a documented phenomenon, clinically significant AP in the post-operative setting is poorly described in the literature and little is understood about the underlying pathophysiology. Additionally, while gastrointestinal fistulae are a well-recognized complication of bowel surgery, nil previous reports discuss the possible contribution of post-operative AP to their development. We present a case of AP complicated by enterocutaneous fistula following extended right hemicolectomy and describe the possible mechanisms leading to these conditions.

Necrotising fasciitis (NF) is a rapidly progressive infection of soft tissue and fascia. Early diagnosis and prompt extensive surgical debridement decrease mortality. This remains a challenge for rural surgeons who have limited experience with the disease, in a setting where patient transfers to tertiary centres are lengthy and often delayed. To assist clinical decision making in this setting, a case series of five NF presentations in a rural Australian hospital were retrospectively analysed for presentation, investigation, treatment and clinical outcomes. Three underwent abdominal wall debridement and two underwent below knee amputation. Results demonstrate early recognition of NF and the extent of surgical intervention prior to acute transfer are key to successful outcomes. Expedient diagnosis and early extensive debridement at the initial contact reduce mortality and should be the goal of management in this setting.