1427 Minimally Invasive Treatment for Severe Acute Pancreatitis With Colonic Stenosis

Abstract

INTRODUCTION: Colonic stenosis is a rare complication of acute pancreatitis (AP). It may be the consequence of inflammation and necrosis caused by AP. Early intervention is necessary, since the progression of colonic stenosis in AP leads to high mortality. We present a case of stenosis of right colic flexure in AP with total minimally invasive treatment. CASE DESCRIPTION/METHODS: A 73-year-old male patient with severe AP due to biliary lithiasis was transferred to our hospital because of recurrent infection and fever at the local hospital. The patient had upper and right lower quadrant abdominal pain at admission. Computed tomography (CT) revealed enveloping necrosis around pancreatic head and exudation of the ascending mesenteric side. CT-guided percutaneous catheter drainage was performed to relieve abdominal and peripancreatic abscess. One week after admission, the patient experienced acute onset severe dull pain in the lower right abdomen. CT showed closed loop ileus from ascending colon to transverse colon (Figure 1a). The colonoscopy revealed the stenosis of right colic flexure and adjacent part of transverse colon and the narrow section was 6 cm (Figure 2a). A fully covered intestinal stent (2 cm × 10 cm) was implanted under colonoscopy (Figure 2b, c). Postoperative CT revealed intestinal stent was in place (Figure 1b). The symptom was quickly controlled after implantation. Meanwhile, pancreatic duct stent was implanted to control the pancreatic fistula. The patient recovered smoothly with the supportive treatment and irrigation tubes were removed before discharge. After 2 months of discharge, CT presented a little necrosis around pancreas and colonic stenosis disappeared (Figure 1c). It was found that the stent had been extruded and right colonic flexure was slightly narrow by colonoscopy (Figure 2d). DISCUSSION: Colonic stenosis secondary to AP is uncommon. It may result from diffusion of inflammation by pancreatic enzymes and pancreatic necrosis. The anatomic relationship of the pancreas and large bowel is an important factor. In this case, stenosis of right colonic flexure is related with necrosis around pancreatic head. Colonic stenosis in AP can progress to colonic ischemia, necrosis and perforation, leading to very poor prognosis It needs operation and resection. Therefore, timely treatment is important. Here, we used total minimally invasive techniques, including implantation of pancreatic duct stent and colonic stent, to prevent detrimental consequence. The prognosis of the patient is good.