[Colonic stenosis in pancreatitis]

The author's personal series consists of 9 patients, representing 1.5 per cent of cases of chronic pancreatitis and 7 per cent of cases of acute pancreatitis. In the literature, this frequency is reported as being in the order of 2 to 3 per cent. Colonic involvement may be either acute as a result of ischaemia and necrosis due to acute pancreatitis or chronic, following acute pancreatitis or an acute episode of chronic pancreatitis by retraction of the colon or by compression by a pancreatic pseudocyst. The patient frequently presents with an acute intestinal obstruction. The most frequent site is in the left colonic flexure in 5 out of 9 cases (52 per cent in the literature). In general, the colonic involvement occurs as a result of the diffusion of the necrotic process in the mesentery. The diagnosis is based on the barium enema. Preservation of the mucous border is accompanied by mucosal inflammatory signs. The authors have identified two elements predictive of regression: the absence of fixed stenosis and the presence of mucosal inflammatory signs and the normal external appearance of the colon at exploratory laparotomy. During acute pancreatitis, colonic surgery is only required in the cases of an acute intestinal obstruction or necrosis associated with colonic stenosis. The surgical indications are more extensive in the case of chronic pancreatitis: fixed stenosis with definite signs of obstruction. The usual treatment in this case is colonic resection.