A rare case report of ascending colon perforation secondary to acute pancreatitis
•Knowledge about colonic perforation secondary to acute pancreatitis has been limited to a few case reports, thus diagnostic and management dilemmas continue to persist.•The exact pathogenesis by which pancreatic pseudocysts rupture into the colon is unknown. There have been several purported theori...
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| Veröffentlicht in: | International journal of surgery case reports 2019-01, Vol.55, p.62-65 |
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| creator | Dhadlie, Sunny Ratnayake, Sujith |
| description | •Knowledge about colonic perforation secondary to acute pancreatitis has been limited to a few case reports, thus diagnostic and management dilemmas continue to persist.•The exact pathogenesis by which pancreatic pseudocysts rupture into the colon is unknown. There have been several purported theories.•The management of colonic complications secondary to severe acute pancreatitis relies on a high index of suspicion, as the clinical presentation in non-specific, varied and can occur late in the disease process.
Severe acute pancreatitis is associated with high morbidity and mortality. This is a result of the development of pancreatic and extra-pancreatic necrosis with subsequent infection which can lead to multiorgan failure. Complications include localized ileus, abscess formation, mechanical obstruction, rupture and perforation into the gastrointestinal tract and fistula formation (Aldridge et al., 1989; Bassi et al., 2001 [1,2]).
A 72 year old man attended the emergency department with acute epigastric pain.
Biochemistry results were reviewed with a lipase of 1680 U/L (ref range |
| doi_str_mv | 10.1016/j.ijscr.2018.12.010 |
| format | Article |
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Severe acute pancreatitis is associated with high morbidity and mortality. This is a result of the development of pancreatic and extra-pancreatic necrosis with subsequent infection which can lead to multiorgan failure. Complications include localized ileus, abscess formation, mechanical obstruction, rupture and perforation into the gastrointestinal tract and fistula formation (Aldridge et al., 1989; Bassi et al., 2001 [1,2]).
A 72 year old man attended the emergency department with acute epigastric pain.
Biochemistry results were reviewed with a lipase of 1680 U/L (ref range <60 U/L). He was treated conservatively. He had a labile course throughout his admission and on day 7 he had significant deterioration.
Abdominal CT scan demonstrated marked mechanical large bowel obstruction at the level of the sigmoid colon, caecum dilated with features suggestive of ischaemia in the caecal wall and backflow dilatation of the small bowel loops.
The patient was transferred to a tertiary centre for subsequent laparotomy and bowel resection.
Colonic complications of acute pancreatitis are uncommon. An analysis of pooled data reports the incidence of colonic complications from acute pancreatitis to be 3.3% and those from severe acute pancreatitis 15% (Bassi et al., 2001 [2]).
Knowledge about colonic perforation from acute pancreatitis has been limited to few case reports, thus diagnostic and management dilemmas continue to persist.
We report a rare case of ascending colon perforation in severe acute pancreatitis. This is particularly unusual given the anatomical propensity for splenic flexure involvement or transverse colon involvement being noted in literature. This highlights the high index of suspicion required for colonic complications given the varied, non-specific and often delayed presentation of complications.</description><identifier>ISSN: 2210-2612</identifier><identifier>EISSN: 2210-2612</identifier><identifier>DOI: 10.1016/j.ijscr.2018.12.010</identifier><identifier>PMID: 30690284</identifier><language>eng</language><publisher>Netherlands: Elsevier Ltd</publisher><subject>Acute pancreatitis ; Colon ischaemia ; Colonic perforation ; Pancreatic pseudocyst</subject><ispartof>International journal of surgery case reports, 2019-01, Vol.55, p.62-65</ispartof><rights>2019 The Authors</rights><rights>Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.</rights><rights>2019 The Authors 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c459t-e8c89c7056e63e945ac1658792dc75f552fc92e38a6c6f8e6a08a2612167a4403</citedby><cites>FETCH-LOGICAL-c459t-e8c89c7056e63e945ac1658792dc75f552fc92e38a6c6f8e6a08a2612167a4403</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6351346/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ijscr.2018.12.010$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,3541,27915,27916,45986,53782,53784</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30690284$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dhadlie, Sunny</creatorcontrib><creatorcontrib>Ratnayake, Sujith</creatorcontrib><title>A rare case report of ascending colon perforation secondary to acute pancreatitis</title><title>International journal of surgery case reports</title><addtitle>Int J Surg Case Rep</addtitle><description>•Knowledge about colonic perforation secondary to acute pancreatitis has been limited to a few case reports, thus diagnostic and management dilemmas continue to persist.•The exact pathogenesis by which pancreatic pseudocysts rupture into the colon is unknown. There have been several purported theories.•The management of colonic complications secondary to severe acute pancreatitis relies on a high index of suspicion, as the clinical presentation in non-specific, varied and can occur late in the disease process.
Severe acute pancreatitis is associated with high morbidity and mortality. This is a result of the development of pancreatic and extra-pancreatic necrosis with subsequent infection which can lead to multiorgan failure. Complications include localized ileus, abscess formation, mechanical obstruction, rupture and perforation into the gastrointestinal tract and fistula formation (Aldridge et al., 1989; Bassi et al., 2001 [1,2]).
A 72 year old man attended the emergency department with acute epigastric pain.
Biochemistry results were reviewed with a lipase of 1680 U/L (ref range <60 U/L). He was treated conservatively. He had a labile course throughout his admission and on day 7 he had significant deterioration.
Abdominal CT scan demonstrated marked mechanical large bowel obstruction at the level of the sigmoid colon, caecum dilated with features suggestive of ischaemia in the caecal wall and backflow dilatation of the small bowel loops.
The patient was transferred to a tertiary centre for subsequent laparotomy and bowel resection.
Colonic complications of acute pancreatitis are uncommon. An analysis of pooled data reports the incidence of colonic complications from acute pancreatitis to be 3.3% and those from severe acute pancreatitis 15% (Bassi et al., 2001 [2]).
Knowledge about colonic perforation from acute pancreatitis has been limited to few case reports, thus diagnostic and management dilemmas continue to persist.
We report a rare case of ascending colon perforation in severe acute pancreatitis. This is particularly unusual given the anatomical propensity for splenic flexure involvement or transverse colon involvement being noted in literature. This highlights the high index of suspicion required for colonic complications given the varied, non-specific and often delayed presentation of complications.</description><subject>Acute pancreatitis</subject><subject>Colon ischaemia</subject><subject>Colonic perforation</subject><subject>Pancreatic pseudocyst</subject><issn>2210-2612</issn><issn>2210-2612</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNp9UU1LAzEQDaJoqf0FguTopWuS3c1mDwoifkFBBD2HODtbU7abNUkF_72prUUvzmUG5s2bN_MIOeEs44zL80VmFwF8JhhXGRcZ42yPjITgbCokF_u_6iMyCWHBUuRCSSEOyVHOZM2EKkbk6Yp645GCCUg9Ds5H6lpqAmDf2H5OwXWupwP61nkTbaoDgusb4z9pdNTAKiIdTA8eUzvacEwOWtMFnGzzmLzc3jxf309nj3cP11ezKRRlHaeoQNVQsVKizLEuSgNclqqqRQNV2ZalaKEWmCsjQbYKpWHKrM_hsjJFwfIxudzwDqvXJTZJb_Sm04O3y6RNO2P1305v3_TcfWiZlzwvZCI42xJ4977CEPXSprO7zvToVkELXtWFkHWhEjTfQMG7EDy2uzWc6bUfeqG__dBrPzQXOvmRpk5_K9zN_Hw_AS42AEx_-rDodQCLPWBjPULUjbP_LvgCxJ2duA</recordid><startdate>20190101</startdate><enddate>20190101</enddate><creator>Dhadlie, Sunny</creator><creator>Ratnayake, Sujith</creator><general>Elsevier Ltd</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20190101</creationdate><title>A rare case report of ascending colon perforation secondary to acute pancreatitis</title><author>Dhadlie, Sunny ; Ratnayake, Sujith</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c459t-e8c89c7056e63e945ac1658792dc75f552fc92e38a6c6f8e6a08a2612167a4403</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Acute pancreatitis</topic><topic>Colon ischaemia</topic><topic>Colonic perforation</topic><topic>Pancreatic pseudocyst</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dhadlie, Sunny</creatorcontrib><creatorcontrib>Ratnayake, Sujith</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>International journal of surgery case reports</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dhadlie, Sunny</au><au>Ratnayake, Sujith</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A rare case report of ascending colon perforation secondary to acute pancreatitis</atitle><jtitle>International journal of surgery case reports</jtitle><addtitle>Int J Surg Case Rep</addtitle><date>2019-01-01</date><risdate>2019</risdate><volume>55</volume><spage>62</spage><epage>65</epage><pages>62-65</pages><issn>2210-2612</issn><eissn>2210-2612</eissn><abstract>•Knowledge about colonic perforation secondary to acute pancreatitis has been limited to a few case reports, thus diagnostic and management dilemmas continue to persist.•The exact pathogenesis by which pancreatic pseudocysts rupture into the colon is unknown. There have been several purported theories.•The management of colonic complications secondary to severe acute pancreatitis relies on a high index of suspicion, as the clinical presentation in non-specific, varied and can occur late in the disease process.
Severe acute pancreatitis is associated with high morbidity and mortality. This is a result of the development of pancreatic and extra-pancreatic necrosis with subsequent infection which can lead to multiorgan failure. Complications include localized ileus, abscess formation, mechanical obstruction, rupture and perforation into the gastrointestinal tract and fistula formation (Aldridge et al., 1989; Bassi et al., 2001 [1,2]).
A 72 year old man attended the emergency department with acute epigastric pain.
Biochemistry results were reviewed with a lipase of 1680 U/L (ref range <60 U/L). He was treated conservatively. He had a labile course throughout his admission and on day 7 he had significant deterioration.
Abdominal CT scan demonstrated marked mechanical large bowel obstruction at the level of the sigmoid colon, caecum dilated with features suggestive of ischaemia in the caecal wall and backflow dilatation of the small bowel loops.
The patient was transferred to a tertiary centre for subsequent laparotomy and bowel resection.
Colonic complications of acute pancreatitis are uncommon. An analysis of pooled data reports the incidence of colonic complications from acute pancreatitis to be 3.3% and those from severe acute pancreatitis 15% (Bassi et al., 2001 [2]).
Knowledge about colonic perforation from acute pancreatitis has been limited to few case reports, thus diagnostic and management dilemmas continue to persist.
We report a rare case of ascending colon perforation in severe acute pancreatitis. This is particularly unusual given the anatomical propensity for splenic flexure involvement or transverse colon involvement being noted in literature. This highlights the high index of suspicion required for colonic complications given the varied, non-specific and often delayed presentation of complications.</abstract><cop>Netherlands</cop><pub>Elsevier Ltd</pub><pmid>30690284</pmid><doi>10.1016/j.ijscr.2018.12.010</doi><tpages>4</tpages><oa>free_for_read</oa></addata></record> |
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| source | Elsevier ScienceDirect Journals Complete - AutoHoldings; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Acute pancreatitis Colon ischaemia Colonic perforation Pancreatic pseudocyst |
| title | A rare case report of ascending colon perforation secondary to acute pancreatitis |
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