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Pyun, Kim, Ye, Byeon, Myung, Yang, Kim, and Yoon: Two Cases of Colonic Obstruction after Acute Pancreatitis
Original Article

Korean J Gastroenterol 2009;54(3):180-185.

Published online: 21 February 2009

DOI: https://doi.org/10.4166/kjg.2009.54.3.180

Two Cases of Colonic Obstruction after Acute Pancreatitis

Dae Keun Pyun, M.D., Kyung Jo Kim, M.D., Byong Duk Ye, M.D., Jeong Sik Byeon, M.D., Seung Jae Myung, M.D., Suk Kyun Yang, M.D., Jin Ho Kim, M.D., Sang Nam Yoon, M.D.∗

Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea

Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea

Correspondence to: Kyung Jo Kim, M.D. Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1, Pungnap 2-dong, Songpa-gu, Seoul 138-736, Korea Tel: +82-2-3010-3196, Fax: +82-2-485-5782 E-mail: capsulendos@gmail.com

Received 29 March 2009       Accepted 12 April 2009

Copyright © 2009 The Korean Journal of Gastroenterology

Abstract

Several forms of colonic complications are rarely observed during the clinical course of acute pancreatitis, and potentially fatal in some cases. Colonic lesions associated with acute pancreatitis can be divided into several groups from a pathogenic point of view. Possible pathogenesis includes 1) spread of pancreatic enzymes through the retroperitoneum to mesocolon, causing pericolitis, 2) external inflammatory compression by mesocolic mass secondary to necrosis of fatty tissue, and 3) hypotension due to shock, and thrombosis of mesenteric arteries. These might lead to colonic infarction, fistula formation, perforation, and obstruction during follow-up. We report two cases of colonic obstruction following acute pancreatitis with possible different mechanisms and review Korean cases. One patient developed colonic obstruction due to severe necrotizing pancreatitis, possibly as a result of pericolitis, and the other developed stenosis as a result of ischemic colitis induced by acute pancreatitis.

Keywords: Pancreatitis, Complication, Intestinal obstruction

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Fig. 1.
Case 1. Abdominal CT findings on admission. (A) Extensive amount of peripancreatic fluid collection extending to pararenal space was observed. (B) Distal ascending colon obstruction with proximal bowel dilatation was seen.
kjg-54-180f1.tif
Fig. 2.
Case 1. Colonoscopic findings on 59th hospital day. In the distal ascending colon, luminal narrowing with mucosal edema and hyperemic changes were observed. Self-expanding metallic stent was inserted.
kjg-54-180f2.tif
Fig. 3.
Case 2. Colonoscopic findings in the descending colon during initial hospital course of pancreatitis (A) and late obstruction event (B). (A) Longitudinal ulcer with edema and bleeding was seen, which was compatible with ischemic colitis. (B) Stricture, mucosal nodularity, and hyperemic changes were noted.
kjg-54-180f3.tif
Fig. 4.
Case 2. Abdominal CT findings on admission. Stenosis of the descending colon with proximal bowel dilatation was noted. Arrow indicates stenosed descending colon.
kjg-54-180f4.tif
Table 1.
Clinical Features of Colonic Complications after Pancreatitis
Age Sex Etiology Interval after pancreatitis CT grade Colon complication Colon Segment Involved Colonoscopy Findings Treatment Outcome
Case 1 49 M Alcoholic 46 days E Obstruction A∗ Edema Ileostomy Recovery
Case 2 45 M Alcoholic 27 days E Obstruction SF†, D‡ Stenosis, hyperemia Bypass Recovery
Yoo11 43 M Alcoholic 42 days E Obstruction D Resection Recovery
Chung10 46 M Alcoholic 17 days E Obstruction SF Edema, hemorrhage Ileostomy Death
Sohn9 10 M Unknown 10 days E Obstruction D Normal mucosa Resection Recovery
Han8 41 F CRF 21 days E Infarction A Resection Death
Cho7 56 M Alcoholic - Obstruction SF, D Edema, erosion Resection Recovery
Cho6 63 M Alcoholic 29 days D Perforation T§ Hyperemia Resection Recovery
Kim5 53 M Alcoholic 60 days E Fistula T Drainage Recovery

∗ Ascending colon.

† Splenenic flexure.

‡ Descending colon.

§ Transverse colon.

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