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Published on: March 12, 2019
Descending colon fistula: Unusual complication of severe acute pancreatitis a case report
Haithem Zaafouri1, Atif Dawood1, Meriam Mesbahi2
1Department of General Surgery, King Abdul Aziz Hospital, Jeddah, Saudi Arabia.
Introduction:
The incidence of colonic complications from acute pancreatitis (AP) and severe AP are 3.3% and 15%, respectively. We report a case of descending colon fistula secondary to severe AP and its management.
Case Presentation:
We report a case of a 35-year-old male hospitalized in our department for severe acute pancreatitis (grade E of Balthazar classification).Initially, the evolution was favorable under medical management. Two months later, he was readmitted for infection of the necrosis with a descending colon fistula. As we did not have the possibility of performing a CT scan drainage, our plan was to do surgical drainage under general anesthesia.
Conclusion:
The colonic involvement following AP or severe AP is rare and difficult to diagnoses. Conservative treatment when some conditions are available should be the best choice; it is associated with lower risk of morbidity and mortality.
Insights
Severe acute pancreatitis (AP) can lead to rare colonic complications like fistulas. This case highlights the management of a descending colon fistula secondary to severe AP, emphasizing conservative treatment when feasible.
Area of Science:
- Gastroenterology
- Surgical Case Reports
Background:
- Colonic complications occur in 3.3% of acute pancreatitis (AP) cases and 15% of severe AP cases.
- These complications, including fistulas, are rare and challenging to diagnose.
Observation:
- A 35-year-old male with severe AP (Balthazar grade E) developed a descending colon fistula with infected necrosis.
- Initial medical management was favorable, but complications arose two months later.
Findings:
- The case involved surgical drainage under general anesthesia due to the inability to perform CT-guided drainage.
- Conservative treatment is recommended when possible for colonic involvement post-AP due to lower morbidity and mortality.
Implications:
- This case underscores the importance of recognizing and managing rare colonic fistulas secondary to severe AP.
- Highlights the potential need for surgical intervention when conservative measures or advanced imaging are not options.
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