91 Colon Involvement in Necrotizing Pancreatitis—Incidence, Predictors and Outcomes From a Single Tertiary Care Center

Abstract

INTRODUCTION: Colonic involvement significantly impacts the clinical course of necrotizing pancreatitis (NP) and reported in 6–40%. The spectrum of colonic complications includes fistula, strictures and ischemic colitis. The study aimed to determine the incidence, risk factors and clinical outcomes of colonic involvement of NP managed in our institution. METHODS: A retrospective analysis of all NP patients managed at our institution between 2010–2019 was performed from a prospectively maintained database for the occurrence of colonic complications. Baseline demographic characteristics, clinical presentation, management and outcomes were extracted. RESULTS: Colonic involvement occurred in 20 (3.9%) of the 515 NP patients managed during the study period, with colon fistulation detected in 12 (2.3%), strictures in 6 (1.2%) and ischemic colitis in 2 (0.4%). Males were predominantly involved [16 (80%)]. The median (range) age was 56 (23–84) years and alcohol was the main etiology of pancreatitis [10 (50%)]. All patients had extensive pancreatic and extra-pancreatic necrosis, with average BISAP score of 3 and modified Marshall score of 5. Infected necrosis noted in 18 (90%) patients. Subsequently, all underwent endoscopic and/or percutaneous drainage. Fistulae involved the left colon (mainly splenic flexure) in 9 (69.2%) and the right colon in 4 (30.8%) patients. While spontaneous closure occurred in 7 (53.8%); 4 (30.8%) were managed with over the scope clips and 2 (15.4%) surgically. Clinical outcomes were successful in 11 (92%) and all-cause mortality was 2 (17%). Colonic strictures and ischemia were managed conservatively in 3 (37.5%) subjects; 3 (37.5%) had stent placement, 1 (12.5%) underwent balloon dilation, and 1 (12.5%) underwent right sided hemicolectomy. Outcome was successful in all 8 (100%) patients. CONCLUSION: Male gender, obesity, alcohol etiology, infected necrosis, extensive pancreatic and extra-pancreatic involvement, and need for adjuvant percutaneous drainage may be predictors for development of colon complications in NP. Majority resolved conservatively after complete debridement of necrotic collection, some needed endoscopic management and very few needed surgical interventions.