Korean J Gastroenterol.  2009 Sep;54(3):180-185. 10.4166/kjg.2009.54.3.180.

Two Cases of Colonic Obstruction after Acute Pancreatitis

• Pyun DK
• Kim KJ
• Ye BD
• Byeon JS
• Myung SJ
• Yang SK
• Kim JH
• Yoon SN

• KMID: 1775955
• DOI: http://doi.org/10.4166/kjg.2009.54.3.180

Abstract

Several forms of colonic complications are rarely observed during the clinical course of acute pancreatitis, and potentially fatal in some cases. Colonic lesions associated with acute pancreatitis can be divided into several groups from a pathogenic point of view. Possible pathogenesis includes 1) spread of pancreatic enzymes through the retroperitoneum to mesocolon, causing pericolitis, 2) external inflammatory compression by mesocolic mass secondary to necrosis of fatty tissue, and 3) hypotension due to shock, and thrombosis of mesenteric arteries. These might lead to colonic infarction, fistula formation, perforation, and obstruction during follow-up. We report two cases of colonic obstruction following acute pancreatitis with possible different mechanisms and review Korean cases. One patient developed colonic obstruction due to severe necrotizing pancreatitis, possibly as a result of pericolitis, and the other developed stenosis as a result of ischemic colitis induced by acute pancreatitis.

Keyword

Pancreatitis; Complication; Intestinal obstruction

MeSH Terms

Acute Disease
Colonic Diseases/*diagnosis/etiology
Constriction, Pathologic/diagnosis
Diagnosis, Differential
Humans
Intestinal Obstruction/*diagnosis/etiology/surgery
Male
Middle Aged
Pancreatitis/complications/*diagnosis
Pancreatitis, Acute Necrotizing/complications/*diagnosis
Tomography, X-Ray Computed

Figure

• 

  Fig. 1. Case 1. Abdominal CT findings on admission. (A) Extensive amount of peripancreatic fluid collection extending to pararenal space was observed. (B) Distal ascending colon obstruction with proximal bowel dilatation was seen.

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  Fig. 2. Case 1. Colonoscopic findings on 59th hospital day. In the distal ascending colon, luminal narrowing with mucosal edema and hyperemic changes were observed. Self-expanding metallic stent was inserted.

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  Fig. 3. Case 2. Colonoscopic findings in the descending colon during initial hospital course of pancreatitis (A) and late obstruction event (B). (A) Longitudinal ulcer with edema and bleeding was seen, which was compatible with ischemic colitis. (B) Stricture, mucosal nodularity, and hyperemic changes were noted.

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  Fig. 4. Case 2. Abdominal CT findings on admission. Stenosis of the descending colon with proximal bowel dilatation was noted. Arrow indicates stenosed descending colon.

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