Acute Pancreatitis Causing Descending Colonic Stricture: A Rare Sequelae

Area of Science:

• Gastroenterology
• Surgical Pathology

Background:

• Isolated descending colonic strictures present with nonspecific symptoms, complicating diagnosis.
• Crohn's disease (CD) and tuberculosis (TB) are common causes, often indistinguishable from pancreatitis-related strictures.
• Endoscopic and biopsy findings may be inconclusive, necessitating surgical intervention for definitive diagnosis and treatment.

Observation:

• A young male presented with weight loss and abdominal pain, initially suspected to have CD based on negative TB testing and positive ELISA.
• Despite sulfasalazine treatment for presumed CD, the patient's condition worsened.
• Further investigation revealed a descending colonic stricture unrelated to CD, linked to a prior acute pancreatitis episode.

Findings:

• The patient underwent segmentectomy for a colonic stricture adherent to the pancreas, confirmed to be a rare complication of acute pancreatitis.
• The pathophysiology of pancreatitis-induced colonic stricture is likely inflammatory injury.
• This case highlights the diagnostic challenges posed by colonic strictures secondary to pancreatitis.

Implications:

• Clinicians should consider pancreatitis as a potential etiology for isolated colonic strictures, even with typical CD or TB presentations.
• Advanced imaging and potentially surgical exploration are crucial for differentiating causes of colonic strictures.
• Recognizing this rare complication can prevent delayed diagnosis and inappropriate treatment for pancreatitis-related colonic strictures.