Transverse colon perforation secondary to necrotizing pancreatitis: a rare and life-threatening complication

A 43-year-old man with prior alcohol use and chronic smoking presented with abdominal pain, melena, and fever, on a background of subacute epigastric pain. CT imaging revealed Balthazar E necrotizing pancreatitis with transverse colonic thickening and signs of sealed perforation. Emergency laparotomy uncovered purulent peritonitis and a large perforation of the mid-transverse colon adherent to necrotic pancreatic tissue. A right extended hemicolectomy with double stoma and retroperitoneal lavage was performed. Histopathology confirmed colonic wall necrosis without malignancy. This case illustrates a rare and life-threatening colonic complication of necrotizing pancreatitis. It emphasizes the importance of early suspicion, cross-sectional imaging, and timely surgical management in reducing morbidity and mortality in such complex settings.