Pascual M, Pera M, Martínez I, Miquel R, Grande L
Unidad de Cirugía Colorrectal, Servicio de Cirugía, Hospital del Mar, Barcelona, Spain.
Gastroenterol Hepatol. 2005 Jun-Jul;28(6):326-8. doi: 10.1157/13076349.
Colonic involvement in patients with severe acute pancreatitis or chronic pancreatitis is common and complications such as paralytic ileus, segmental necrosis and pancreatic-colonic fistulae have been described. However, mechanical occlusion of the colon due to pancreatitis is infrequent. We present the case of a 45-year-old man with occlusion of the colon secondary to asymptomatic pancreatitis mimicking a locally advanced stenosing neoplasm of the splenic angle. Ten years prior to the present episode the patient had presented acute alcoholic pancreatitis complicated by a pseudocyst requiring surgery. The current reason for admission was abdominal colic pain and constipation with onset 5 days previously. Contrast enema was administered showing colonic occlusion caused by stenosis at the splenic flexure, suggesting the presence of a neoplasm. Urgent laparotomy showed the presence of a tumor originating in the colon that infiltrated the splenic hilum. Subtotal colectomy and en-bloc splenectomy were performed. Histopathological analysis showed pericolonic inflammation and fibrosis secondary to pancreatitis; the colonic mucosa showed no tumoral infiltration. To date, fewer than 30 cases of this infrequent complication have been published.
重症急性胰腺炎或慢性胰腺炎患者出现结肠受累很常见,且已报道过诸如麻痹性肠梗阻、节段性坏死和胰结肠瘘等并发症。然而,胰腺炎导致的结肠机械性梗阻并不常见。我们报告一例45岁男性患者,其结肠梗阻继发于无症状胰腺炎,酷似脾曲局部进展性狭窄性肿瘤。本次发病前10年,该患者曾出现急性酒精性胰腺炎并伴有假性囊肿,需手术治疗。此次入院的原因是5天前开始出现腹部绞痛和便秘。行结肠造影显示脾曲狭窄导致结肠梗阻,提示存在肿瘤。急诊剖腹探查显示结肠有一肿瘤,已浸润脾门。遂行结肠次全切除术和脾整块切除术。组织病理学分析显示胰腺炎继发结肠周围炎症和纤维化;结肠黏膜未见肿瘤浸润。迄今为止,这种罕见并发症的病例报道少于30例。