Colonic complications of pancreatitis

A retrospective review of 296 patients referred for surgical management of pancreatitis from 1964 to 1992 revealed that 18 (6.1%) had colonic complications. Of seven patients with chronic pancreatitis, six developed pancreatocolonic fistulas. One had stenosis of the transverse colon, which resolved after pancreatic cystjejunostomy, three were managed with local fistula excision and simple colon closure, three had segmental colectomy, and in one the fistula closed spontaneously with expectant management. Three patients had concomitant lateral pancreaticojejunostomy, and two had a cystjejunostomy. There were two postoperative complications, but no mortality. Eleven patients had acute necrotizing pancreatitis. Seven developed segmental colonic infarction that required partial colectomy. Four had colonic fistulas, two managed with partial colectomy and colostomy, and two managed nonoperatively. Eleven patients developed major postoperative complications; four died, two from sepsis and multiorgan failure and two from recurrent hemorrhage from a necrotic pancreatic bed. Our findings indicate that the presentation, management, and outcome of colonic complications differ in chronic and acute pancreatitis. In chronic pancreatitis, pancreatocolonic fistula predominated and could be managed either with local excision or segmental resection of the colon with excellent results. Simultaneous surgical correction of associated pancreatic pathology was possible in five patients. In acute necrotizing pancreatitis, colonic infarction secondary to the necrotizing inflammatory process was frequent and required colon resection. There was substantial morbidity and mortality in spite of treatment with colectomy.