A Case of Colonic Penetration and Colonic Stenosis Complicated with Severe Acute Pancreatitis

Abstract

A 76-year-old female consulted her general practitioner with a chief complaint of abdominal pain, and she was diagnosed as having severe acute pancreatitis. She received conservative treatment, however, her clinical conditions got worse, and she was brought to our hospital. The prognostic signs were positive for five parameters and the CT grade was judged to be grade 2. Abdominal CT showed the presence of free air in the mesocolon transversum. Emergency surgery was performed, because the patient had general peritonitis and disseminated intravascular coagulation (DIC). Although fat necrosis was found in the mesocolon transversum due to colonic penetration, there was no necrotic finding in the transverse colon. Ileostomy and drainage were therefore carried out. Although colonic perforation and colonic stenosis were demonstrated, these complications were improved by conservative treatment, and the patient was discharged from our hospital 155 days after the operation. The colonic stenosis had improved 1 year after the operation, and she is doing well with comfortable activities of daily life.