A rare case of perforated caecum after acute pancreatitis

Gastrointestinal complications in acute and chronic pancreatitis

Pancreatitis is one of the important medical conditions. Gastrointestinal (GI) complications of pancreatitis are important and lead to significant morbidity and mortality. Diagnosis of these complications is difficult and may require a strong clinical suspicion coupled with various imaging features. This review provides an extensive update of the whole spectrum of GI complication of pancreatitis, both acute and chronic, from inflammation, ischemia, and necrosis to obstruction, perforation, and GI fistulae. The focus is on the clinical and imaging features of this less commonly described aspect of pancreatitis.

CT evaluation and clinical factors predicting delayed colonic perforation following acute pancreatitis

PURPOSE

Delayed colonic perforation after acute pancreatitis (AP) is a potentially lethal complication. This study investigated the frequency and predictors of delayed colonic perforation (DCP) following AP by reviewing the earliest laboratory data and computed tomography (CT) examination findings after pancreatitis onset.

MATERIALS AND METHODS

This retrospective study examined 75 consecutive cases of AP treated between April 2009 and April 2014. Laboratory data after onset and imaging features from earliest CT examinations (Balthazar grade, CT Severity Index) were reviewed. To clarify relationships between these data and DCP, univariate analyses were undertaken between perforated and nonperforated groups.

RESULTS

Delayed colonic perforation occurred in four of the 75 patients (5.3 %). Median duration to perforation after onset was 13 days (range 6-47). All four patients with DCP showed grade E according to Balthazar grade (≥2 peripancreatic collections and/or gas bubbles in or adjacent to pancreas). Univariate analyses identified Balthazar grade E as a risk factor for DCP (p = 0.0087).

CONCLUSION

Delayed colonic perforation is not uncommon and can occur a week or more after AP. Balthazar grade E on earliest CT after onset represents a risk factor for DCP.