Colonic obstruction: a rare complication of acute pancreatitis

Abstract

Colonic obstruction: a rare complication of acute pancreatitis A 37-year-old lady presented with complaints of abdominal pain, distension and vomiting for 2 days. On clinical examination, there was tenderness in the epigastrium. Laboratory investigations revealed serum hyperamylasaemia suggestive of acute pancreatitis. Computed tomography (CT) of the abdomen performed 1 week after the admission showed gallstones and necrosis involving the head of the pancreas with adjoining peripancreatic collections (Fig. 1). The patient was managed conservatively in the intensive care unit by intravenous fluids, antibiotics and enteral nutrition. During the course of illness, the patient developed new-onset diabetes mellitus with ketoacidosis, hypertension and bilateral pleural effusion which were medically managed. The patient recovered and was discharged after 12 days of hospital stay. During the follow-up visits, after 1 month from the onset of pancreatitis, she complained of colicky abdominal pain with vomiting, constipation and obstipation for 1 day. Contrast-enhanced CT of the abdomen revealed cholelithiasis, acute pancreatitis with small collection near the pancreatic head and adjoining colonic stricture with proximal dilated large and small bowel loops (Fig. 1). Initially, conservative management was tried for 5 days in view of reduction in the size of peripancreatic collection. However, the patient persisted to have abdominal symptoms. Hence, surgery was planned. On diagnostic laparoscopy, about 200 mL of ascites was present. Gallbladder was distended and thickened containing multiple calculi. Right colon was grossly dilated. Laparoscopic cholecystectomy was performed followed by mini-laparotomy. On laparotomy, a tight circumferential inflammatory stricture was present in the transverse colon on the right side causing luminal obstruction (Fig. 2). Intraoperative colonoscopy was done which ruled out colonic mucosal disease. To

Role of Intraoperative Endoscopy in the Management of Small Bowel Diseases

“…Another clinical situation is difficulty in identification of the cause of bowel obstruction. In one of our previously reported cases, a patient of moderately severe acute gallstone pancreatitis developed colonic obstruction in the follow up [19]. On CT abdomen, there was a resolving peripancreatic collection surrounding the transverse colon with grossly dilated ascending colon and small bowel loops.…”

“…In order to rule out mucosal disease, IOE via enterotomy route was performed (Figure 6). As there was no mucosal disease, side-to-side ileo-transverse colonic anastomosis was performed without colonic resection [19].…”