A Case of Severe Acute Pancreatitis with Colonic Penetration

Abstract

We herein report on a patient with severe acute pancreatitis associated with colonic penetration and melena. A 72-year-old woman complaining of abdominal pain and fever was admitted to another hospital under the diagnosis of gallstone cholecystitis. Subsequent CT showed severe acute gallstone pancreatitis (grade IV), where fluid collection around the pancreas and its extent to the left kidney were observed. Percutaneous fluid drainage was performed, because infection was suspected. Although the common bile duct stone spontaneously disappeared, her symptoms were not relieved and an intraabdominal abscess developed. She was referred to our hospital. While under conservative therapy, she noticed melena, and fistulography demonstrated that the abscess cavity had penetrated the descending colon. Because of these findings and repeated melena, emergency surgery was performed. Since a lot of necrotic tissue in the retroperitoneum and necrosis of the mesocolon were observed, necrosectomy and left colectomy with transverse colostomy were carried out. She was discharged from hospital on postoperative day 77. Six patients with acute pancreatitis penetrating the colon have been reported in the literature. We report on our case together with these six patients.