Colonic complications of severe acute pancreatitis

Abstract

Colonic complications are rare in acute pancreatitis. Over the last 9 years at St. Mary's Hospital, London, UK, we have managed severe acute pancreatitis by intensive supportive therapy followed by sub-total pancreatic resection and/or debridement in those who fail to improve. Of the 22 patients who have undergone this form of surgery, nine were found to have colonic involvement in the form of either necrosis or perforation. In addition, one patient presenting at West Middlesex University Hospital, Isleworth, UK, had severe acute pancreatitis and almost total colonic necrosis as an unexpected finding at emergency laparotomy. These ten patients comprised seven men and three women of median age 59 years and with a median of four Ranson criteria. In seven patients, colonic involvement was discovered at the time of pancreatic surgery or laparotomy for pancreatitis and in the remainder it presented between 1 and 3 weeks later as either a faecal fistula (n = 2) or persistent abdominal sepsis (n = 1). The ascending colon was involved in one patient, the splenic flexure and descending colon in one, the transverse colon in three, the splenic flexure alone in four, and one patient had almost total colonic involvement. All patients underwent resection of the involved colon and exteriorization with either a proximal colostomy (n = 7) or ileostomy (n = 3) and a distal mucous fistula. Pathological examination of the resected colons revealed a spectrum of changes from pericolitis through to ischaemic necrosis suggesting at least two possible mechanisms. Six patients died from overwhelming sepsis between 1 day and 4 weeks (median 11 days) after colonic resection. Severe acute pancreatitis must be recognized as a cause of colonic ischaemia and necrosis; this complication is associated with a very poor prognosis despite surgical intervention.

A rare case of perforated caecum after acute pancreatitis

“…Aldridge et al described colonic involvement associated with severe acute pancreatitis over nine years at St Mary's Hospital, London. 1 Of the 22 patients undergoing subtotal pancreatic resection and/or debridement, 9 had colonic involvement noted during or after surgery (perforation or necrosis). One patient had involvement of the ascending colon.…”

Development of Colonic Necrosis Following Severe Acute Pancreatitis.

“…The most common manifestation is colonic ileus, which can be seen as the "colon cut-off sign on plain abdominal film. Necrosis of the colon rarely complicates acute pancreatitis (4,5). In this article, we report a patient with acute pancreatitis whodeveloped serious colonic necrosis.…”

Necrotizing colitis complicating necrotized pancreatitis: look out for intestinal pneumatosis

“…He had no previous hospital admissions and no previous similar episodes, but confessed havpancreatitis, appendicitis, diverticulitis, and peritonitis. Pancreatitis is associated with wide spectrum of colon lesions, including ileus, ischemic necrosis and fistula formation, the reported incidence being 1-15% among adult cases (1). In one series, 27% of patients with acute pancreatitis were complicated by ischemic enterocolitis (2).…”