Here, I wanted to share an interesting case of severe acute pancreatitis associated with severe complications recently published in the ACG case report journal.
A 60-year-old woman with a history of eosinophilic esophagitis presented with acute-onset severe nausea, vomiting, and abdominal pain. She was admitted with acute pancreatitis (AP), which progressed to severe necrotizing pancreatitis with complications, including thrombosis of the superior mesenteric and splenic veins and subsequent sigmoid colon perforation. She underwent emergent exploratory laparotomy with colostomy placement and abdominal drainage. She recovered after a prolonged hospital stay and is doing well in outpatient follow-up.
Colon complications in severe acute pancreatitis (AP) are uncommon, occurring in about 15% of cases, and can include ileus, abscess, obstruction, fistula, and perforation. In the case above, severe pancreatic inflammation led to a rupture in the sigmoid colon about 15 days after symptom onset, aligning with the typical timeframe seen in similar cases.
The cause of colon perforation in severe AP is believed to be a mix of colon ischemia and inflammation from pancreatic enzymes. Perforations typically occur at the splenic flexure due to its proximity to the pancreas and reduced blood flow. In this case, CT scans indicated fluid accumulation near the sigmoid colon before the perforation, suggesting progressive inflammation and possible ischemic changes culminating in perforation.
Please be aware of rare complications of severe pancreatitis and repeat imaging ASAP if questions arise.
Saleh, Hasan MD1; Nimma, Induja R. MD1; Huang, Yuting MD2; Amiraian, Dana MD3; Pang, Maoyin MD2; DeLeon, Michelle MD4; Chan, Johanna MD2; Lewis, Michele D. MD2; Hashash, Jana G. MD, MSc, FACG2. A Rare Case of Sigmoid Colon Perforation in a Patient With Severe Acute Pancreatitis. ACG Case Reports Journal 11(5):p e01357, May 2024. | DOI: 10.14309/crj.0000000000001357