Colonic perforation following endoscopic retrograde cholangiopancreatography-associated pancreatitis

Abstract

We highlight a potentially lethal complication of acute severe pancreatitis that may not be suspected in severely ill patients. A 41-year-old woman developed acute severe pancreatitis following endoscopic retrograde  cholangiopancreatography (ERCP) for suspected choledocholithiasis. When her condition deteriorated dramatically  after 2 weeks of intensive medical management, a computed tomography scan and watersoluble contrast enema  examination revealed a large colonic perforation and associated collection in the right flank. Surgical management included an extended right hemicolectomy and a second laparotomy to attend to soiling at the surgical site. She  survived and was discharged. Colonic perforation is a recognised complication of pancreatitis that carries a high  mortality. It may result from a combination of ischaemia to the colon and a direct effect of noxious pancreatic  enzymes. Almost all cases are only diagnosed at laparotomy. In view of the current trend of non-surgical  management of pancreatitis and associated complications, colonic perforation should be considered in patients who  deteriorate or fail to improve. To our knowledge this is the first case of a secure pre-operative diagnosis of colonic perforation due to to pancreatitis.