Spontaneous perforation of the transverse colon complicating acute pancreatitis: report of a case

Acute pancreatitis followed by retroperitoneal perforation of the descending colon and a duodenal fistula: Report of a case

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Retroperitoneal perforation of the colon must be considered in patients with acute pancreatitis.

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The most common site of perforation is the transverse and descending colon.

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Retroperitoneal drainage may lead to expansion of the perforation site, necessitating a diverting stoma.

Introduction

There are several reports of colon perforation in patients with acute pancreatitis, but the mechanism is not understood. We describe a patient with acute pancreatitis followed by retroperitoneal perforation of the descending colon and a duodenal fistula.

Case presentation

A 51-year-old male presented with acute pancreatitis. He was hemodynamically unstable, had respiratory failure on admission and was treated in the intensive care unit (ICU). He recovered and left the ICU on day 13. Although his general condition improved, a computed tomography (CT) scan showed air and fluid in the left retroperitoneum. Gastrografin enema and CT scan showed extraluminal leakage in the descending colon and retroperitoneal drainage was performed on day 27. After drainage, there was continuous voluminous feculent discharge, and a loop ileostomy was performed on day 34. A repeat CT scan revealed ascites. A percutaneous catheter injected with contrast showed a duodenal fistula. After drainage, the fever resolved and the patient was discharged on hospital day 106.

Discussion

Although there is no clear mechanism of colonic perforation in patients with acute pancreatitis, one hypothesis is that ischemia secondary to inflammation caused by pancreatitis plays a role. The involved area is usually in the watershed areas of the colon. Retroperitoneal drainage of the colon perforation may have necessitated creation of a diverting loop ileostomy.

Conclusion

Retroperitoneal colon perforation must be considered in patients with acute pancreatitis.

A rare case of perforated caecum after acute pancreatitis

Isolated caecal perforation following pancreatitis is a rare event. We report a case of severe non-necrotising pancreatitis complicated by caecal perforation that was managed successfully.

[Colon necrosis as a complication of necrotizing pancreatitis]

Necrosis of the colon is a rare but often fatal complication of necrotizing pancreatitis. Among 159 patients with necrotizing pancreatitis who were treated between 1 January 1986 and 31 December 1988, a colonic lesion developed in 10 patients (6.3%). All 10 patients underwent surgery. With regard to the time of occurrence and the extent of the lesion two types could be distinguished: first, extensive, probably ischemic colonic necrosis developed early in the course of the disease, i.e., within the 1st week; second, localized lesions mainly in the region of the left colonic flexure occurred much later and were considered to be a complication related to persistent infection in the remaining pancreatic necroses. The colonic lesions were treated by resection and fecal diversion in 9 patients and by local excision with direct closure and additional diverting colostomy in one patient. Even though the colonic complications could be controlled, only 1 of the 10 patients survived. This can be explained by the fact that all these patients had a severe form of the disease with extensive pancreatic necroses and were in a septic-toxic state with multiple organ failure at the time the colonic lesion occurred.

Colonic involvement in acute necrotizing pancreatitis: results of surgical treatment

In this series of 15 personal cases, the authors emphasize the unusual colonic complications which occur during acute necrotizing pancreatitis. These lesions always indicate a particularly severe pancreatitis and depend on 2 factors: extension of pancreatic necrosis into the mesocolon with encasing pericolic tumoral fibrosis, and parietal ischemic necrosis secondary to shock and thrombosis with infection. Laparotomy followed by colectomy is indicated in these severely ill patients. Prognosis is poor (8 deaths of 15 patients), sometimes in spite of extensive pancreatic excision. The existence of colonic complications gives evidence of the particular severity of certain forms of pancreatitis.

Colonic necrosis in acute pancreatitis. A complication of massive retroperitoneal suppuration

Colonic necrosis is a rare complication of peripancreatic sepsis following acute pancreatitis. Three patients with colonic necrosis associated with extensive retroperitoneal suppuration are reported. The pathogenesis of this syndrome may be explained by the tendency of pancreatic abscesses to extend widely in the retroperitoneum. Management is discussed, emphasizing the need for an aggressive surgical approach and multiple operations.

Colonic infarction and pancreatitis: a case report

A case of almost total colonic infarction secondary to pancreatitis is described. This appears to be a very rare complication of acute pancreatitis and is a result of mesenteric venous thrombosis secondary to the acute inflammatory process. The clue to the diagnosis was the passage of bright blood per rectum and a rapid deterioration in the condition of a patient with severe pancreatitis. Subtotal colectomy with ileostomy and mucous fistula formation was the treatment of choice. Ileosigmoid anastomosis was performed six months later.

Spontaneous disruption of the colon associated with pyonephrosis: report of a case

We report a case of reno-colic fistula with abscess formation, which was treated by staged surgical procedures. One must be wary of automatically implicating the colon as the primary source of the problem when the colon and adjacent organs are involved in an inflammatory process. In cases involving the superior segments of the colon, the kidney or pancreas may be the source of the fistula.