Dhadlie Sunny, Ratnayake Sujith
Caboolture Hospital, 120 McKean Street, 4510 Queenland, Australia.
Int J Surg Case Rep. 2019;55:62-65. doi: 10.1016/j.ijscr.2018.12.010. Epub 2019 Jan 21.
Severe acute pancreatitis is associated with high morbidity and mortality. This is a result of the development of pancreatic and extra-pancreatic necrosis with subsequent infection which can lead to multiorgan failure. Complications include localized ileus, abscess formation, mechanical obstruction, rupture and perforation into the gastrointestinal tract and fistula formation (Aldridge et al., 1989; Bassi et al., 2001 [1,2]).
A 72 year old man attended the emergency department with acute epigastric pain. Biochemistry results were reviewed with a lipase of 1680 U/L (ref range <60 U/L). He was treated conservatively. He had a labile course throughout his admission and on day 7 he had significant deterioration. Abdominal CT scan demonstrated marked mechanical large bowel obstruction at the level of the sigmoid colon, caecum dilated with features suggestive of ischaemia in the caecal wall and backflow dilatation of the small bowel loops. The patient was transferred to a tertiary centre for subsequent laparotomy and bowel resection.
Colonic complications of acute pancreatitis are uncommon. An analysis of pooled data reports the incidence of colonic complications from acute pancreatitis to be 3.3% and those from severe acute pancreatitis 15% (Bassi et al., 2001 [2]). Knowledge about colonic perforation from acute pancreatitis has been limited to few case reports, thus diagnostic and management dilemmas continue to persist.
We report a rare case of ascending colon perforation in severe acute pancreatitis. This is particularly unusual given the anatomical propensity for splenic flexure involvement or transverse colon involvement being noted in literature. This highlights the high index of suspicion required for colonic complications given the varied, non-specific and often delayed presentation of complications.
重症急性胰腺炎的发病率和死亡率都很高。这是胰腺及胰腺外坏死伴随后续感染发展的结果，可导致多器官功能衰竭。并发症包括局部肠梗阻、脓肿形成、机械性梗阻、破裂和穿孔进入胃肠道以及瘘管形成（奥尔德里奇等人，1989年；巴西等人，2001年[1,2]）。
一名72岁男性因急性上腹部疼痛就诊于急诊科。生化检查结果显示脂肪酶为1680 U/L（参考范围<60 U/L）。他接受了保守治疗。在整个住院期间病情不稳定，第7天病情显著恶化。腹部CT扫描显示乙状结肠水平存在明显的机械性大肠梗阻，盲肠扩张，盲肠壁有缺血迹象，小肠袢出现逆流扩张。患者被转至三级中心接受后续剖腹手术和肠切除术。
急性胰腺炎的结肠并发症并不常见。对汇总数据的分析报告显示，急性胰腺炎结肠并发症的发生率为3.3%，重症急性胰腺炎为15%（巴西等人，2001年[2]）。关于急性胰腺炎导致结肠穿孔的知识仅限于少数病例报告，因此诊断和管理难题仍然存在。
我们报告了一例重症急性胰腺炎导致升结肠穿孔的罕见病例。鉴于文献中指出脾曲或横结肠受累的解剖学倾向，这一病例尤为特殊。鉴于并发症表现多样、非特异性且往往延迟出现，这凸显了对结肠并发症需保持高度怀疑。
