Colonic complications in acute pancreatitis: management experience from a single institution

Amos N. Liew; Raelene Y. M. Tan; Mithra Sritharan; Daniel Croagh

doi:10.18203/2349-2902.isj20251175

Authors

Amos N. Liew Department of General Surgery, Monash Health, Melbourne, Victoria, Australia
Raelene Y. M. Tan Department of General Surgery, Monash Health, Melbourne, Victoria, Australia
Mithra Sritharan Department of General Surgery, Monash Health, Melbourne, Victoria, Australia; Department of Hepatobiliary and Pancreatic Surgery, Monash Health, Melbourne, Victoria, Australia
Daniel Croagh Department of General Surgery, Monash Health, Melbourne, Victoria, Australia; Department of Surgery, Monash University, Melbourne, Victoria, Australia

DOI:

https://doi.org/10.18203/2349-2902.isj20251175

Keywords:

Acute pancreatitis, Necrotising pancreatitis, Colonic complications, Colonic stricture, Colonic stenosis, Colonic perforation

Abstract

Colonic complications secondary to acute pancreatitis (AP) are rare. Management of these pathologies is inconsistent and non-standardized because of their rarity. A retrospective review was performed for patients admitted to our health network with colonic complications secondary to AP from 1st January 2009 to 31st December 2023. 13 patients were admitted at Monash Health between January 2009 and December 2023 for a colonic complication secondary to AP. One had a bowel obstruction secondary to retroperitoneal compression, four had pancreatic-colonic fistulas, three had colonic infarction, two presented with colonic perforation while three presented with obstructive colonic strictures. The most common aetiology was gallstone pancreatitis (n=4). Initial management for colonic fistulas and strictures were commonly with a diverting loop ileostomy, while perforations/necrosis required emergent colectomies with or without diverting stomas. Colonic fistulas in AP can be managed safely with a diverting loop ileostomy to delay or avoid the need for a major resection during the acute phase. However, emergency colonic resection should be performed in the case of colonic perforation or necrosis and is associated with worse outcomes.

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References

Raftopulos NL, Torpy DJ, Louise Rushworth R. Epidemiology of acute pancreatitis in Australia from 2007-2019. ANZ J Surg. 2022;92:92-8. DOI: https://doi.org/10.1111/ans.17215

Boumitri C, Brown E, Kahaleh M. Necrotizing Pancreatitis: Current Management and Therapies. Clinical Endoscopy. 2017;50:357-65. DOI: https://doi.org/10.5946/ce.2016.152

Shyu JY, Sainani NI, Sahni VA, Chick JF, Chauhan NR, Conwell DL, et al. Necrotizing pancreatitis: diagnosis, imaging, and intervention. Radiographics. 2014;34:1218-39. DOI: https://doi.org/10.1148/rg.345130012

Maatman TK, Nicolas ME, Roch AM, Lewellen KA, Al-Azzawi HH, Ceppa EP, et al. Colon Involvement in Necrotizing Pancreatitis: Incidence, Risk Factors, and Outcomes. Ann Surg 2022;275:568-75. DOI: https://doi.org/10.1097/SLA.0000000000004149

Karakayali FY. Surgical and interventional management of complications caused by acute pancreatitis. World J Gastroenterol. 2014;20:13412-23. DOI: https://doi.org/10.3748/wjg.v20.i37.13412

6. Heckler M, Hackert T, Hu K, Halloran CM, Büchler MW, Neoptolemos JP. Severe acute pancreatitis: surgical indications and treatment. Langenbeck's Archives of Surg. 2021;406:521-35. DOI: https://doi.org/10.1007/s00423-020-01944-6

Van Minnen LP, Besselink MG, Bosscha K, Van Leeuwen MS, Schipper ME, Gooszen HG. Colonic involvement in acute pancreatitis. A retrospective study of 16 patients. Dig Surg. 2004;21:33-8. DOI: https://doi.org/10.1159/000075824

Shaikh H, Wehrle CJ, Khorasani-Zadeh A. Anatomy, Abdomen and Pelvis: Superior Mesenteric Artery. StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Chase Wehrle declares no relevant financial relationships with ineligible companies. Disclosure: Arshia Khorasani-Zadeh declares no relevant financial relationships with ineligible companies. 2024.

Zhu AJ, Shi JS, Sun XJ. Organ failure associated with severe acute pancreatitis. World J Gastroenterol. 2003;9:2570-3. DOI: https://doi.org/10.3748/wjg.v9.i11.2570

Hartwig W, Maksan SM, Foitzik T, Schmidt J, Herfarth C, Klar E. Reduction in mortality with delayed surgical therapy of severe pancreatitis. J Gastrointest Surg. 2002;6:481-7. DOI: https://doi.org/10.1016/S1091-255X(02)00008-2

Srinivasan S, Subramanian M, Lim TC, Shenoy J, Majumder A. Pancreatico-Colonic Fistula-Demonstrated by Multidetector-Row CT. Korean J Radiol. 2015;16:446. DOI: https://doi.org/10.3348/kjr.2015.16.2.446

Kochhar R, Jain K, Gupta V, Singhal M, Kochhar S, Poornachandra KS, et al. Fistulization in the GI tract in acute pancreatitis. Gastrointest Endosc. 2012;75:436-40. DOI: https://doi.org/10.1016/j.gie.2011.09.032

Tsiotos GG, Smith CD, Sarr MG. Incidence and management of pancreatic and enteric fistulas after surgical management of severe necrotizing pancreatitis. Arch Surg. 1995;130:48-52. DOI: https://doi.org/10.1001/archsurg.1995.01430010050010

Suzuki A, Suzuki S, Sakaguchi T, Oishi K, Fukumoto K, Ota S, et al. Colonic fistula associated with severe acute pancreatitis: report of two cases. Surg Today. 2008;38:178-83. DOI: https://doi.org/10.1007/s00595-007-3593-6

Rodriguez EM, Sanchez RB, Angel JMR, Olmedo SR, de la Plaza Llamas R, Plaza JM. Spontaneous pancreatic-colinic fistula in a patient with severe acute pancreateitis. Gastroenterol Hepatol. 2015;39:221-3. DOI: https://doi.org/10.1016/j.gastre.2016.02.005

Ito K, Igarashi Y, Mimura T, Kishimoto Y, Kamata I, Kobayashi S, et al. Severe Acute Pancreatitis with Complicating Colonic Fistula Successfully Closed Using the Over-the-Scope Clip System. Case Reports in Gastroenterol. 2013;7:314-21. DOI: https://doi.org/10.1159/000354276

Gray DM, 2nd, Mullady DK. Attempted endoscopic closure of a pancreaticocolonic fistula with an over-the-scope clip. JOP. 2012;13:712-4.

Hwang SO, Lee TH, Park JW, Park SH, Kim SJ. Endoscopic management of multiple colonic fistulae secondary to acute pancreatitis (with video). Gastrointest Endosc. 2010;71:395-7. DOI: https://doi.org/10.1016/j.gie.2009.10.045

Yanar F, Yanar H. Nutritional support in patients with gastrointestinal fistula. Eur J Trauma Emerg Surg. 2011;37:227. DOI: https://doi.org/10.1007/s00068-011-0105-6

Szefel J, Kruszewski WJ, Buczek T. Enteral feeding and its impact on the gut immune system and intestinal mucosal barrier. Prz Gastroenterol. 2015;10:71-7. DOI: https://doi.org/10.5114/pg.2015.48997

Cui B, Zhou L, Khan S, Cui J, Liu W. Role of enteral nutrition in pancreaticocolonic fistulas secondary to severe acute pancreatitis: A case report. Medicine (Baltimore). 2017;96:9054. DOI: https://doi.org/10.1097/MD.0000000000009054

Ridgeway MG, Stabile BE. Surgical management and treatment of pancreatic fistulas. Surg Clin North Am. 1996;76:1159-73. DOI: https://doi.org/10.1016/S0039-6109(05)70504-1

Diaz-Pizarro Graf JI, Kumpf VJ, de Aguilar-Nascimento JE, Hall AM, McKeever L, Steiger E, et al. (ASPEN-FELANPE Clinical Guidelines: Nutrition Support of Adult Patients with Enterocutaneous Fistula). Nutr Hosp. 2020;37:875-85. DOI: https://doi.org/10.20960/nh.03116

Mandal AK, Kafle P, Puri P, Chaulagai B, Hassan M, Bhattarai B, et al. Acute Pancreatitis Causing Descending Colonic Stricture: A Rare Sequelae. J Investigative Med High Impact Case Reports. 2019;7:232470961983459. DOI: https://doi.org/10.1177/2324709619834594