The cumulative 7 d incidence of colonic perforation in this cohort was 0.06%. Advanced age and female gender were significantly more likely to have perforation. Increasing albumin and BMI resulted in decreased risk of colonic perforation. Having a colonoscopy indication of abdominal pain or Crohn's disease resulted in a higher risk of colonic perforation. Colonoscopies performed in inpatients and particularly the ICU setting had substantially greater odds of perforation. Biopsy and polypectomy did not increase the risk of perforation and only three perforations occurred with screening colonoscopy.

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INTRODUCTION: Pancreatic cancer is the leading cause of cancer-related mortality in developed countries. In the United States, 3% of the cancer-related mortalities are caused by pancreatic cancer. Pancreatic cancer commonly metastasizes to lungs, lymph nodes, liver, and peritoneum. Metastasis of pancreatic cancer to the colon is very rare, and few cases have been reported in the literature so far. CASE DESCRIPTION/METHODS: In this case report, we describe a case of a mass in the colonic site which was initially thought to be primary colon cancer. However, on further radiological and histological examination, the mass was confirmed to be a metastatic tumor from a primary pancreatic cancer (Figure 1 shows cancer in the tail of the pancreas). Immunohistochemical markers were used to differentiate between primary pancreatic and primary colon cancer (Figure 2). DISCUSSION: In consideration of this interesting finding, the importance of immunohistochemical markers in the differentiation between primary and metastatic colon cancers based on their expression is emphasized. We emphasize that the pattern of immunohistochemical markers especially the combination of CK7 and CK20 is a useful tool to differentiate between metastasis in the colonic sites and primary colon cancer. We have also described an interesting relation between the side of colonic metastasis and the involved segment of the pancreas which has not been described in the literature before. In this manuscript, we have also compared and analyzed ten previous cases in medical literature with similar presentation of colonic metastasis from pancreatic cancer.

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