Multiple Pancreaticocolonic Fistulas Involving the Transverse and Descending Colon with Multiple Walled-Off Pancreatic Necroses: Reporting of a Complex Case Treated Surgically

Context Pancreaticocolonic fistula is a rare and potentially critical complication of necrotizing pancreatitis. We report a complex case of multiple Pancreaticocolonic fistulas that was successfully treated with extended left hemicolectomy. Case report A forty-three-yearsold male patient, presented in our emergency department with epigastric pain, vomiting, diarrhea and weight loss for 4 weeks duration, with past history of acute gall stone pancreatitis 10 weeks earlier. Contrast enhanced computed tomography abdomen showed multiple Walled-off Pancreatic Necrosis in the peripancreatic, right paracolic and left paracolic regions up to left inguinal region with extensive Pneumoretroperitoneum. The periduodenal collection caused duodenal compression. Laparotomy done for pancreatic necrosectomy, relieving the duodenal compression, and drainage of all collections. We noticed multiple Pancreaticocolonic fistulas, 5 in numbers, between the transverse and descending colon and their neighboring collections, extended left hemicolectomy done. Multiple abdominal drains had been put for continuous postoperative irrigation. The patient discharged home but after 3 months of a hectic post-operative course. Discussion To the best of our knowledge this is the first case to be reported in the literature with multiple walled-off pancreatic necrosis associated with multiple Pancreaticocolonic fistulas (5 in Number) in both transverse and descending colon. Conclusion Necrotizing pancreatitis is a devastating disease, the presence of Pneumoretroperitoneum does not essentially only point to infected necrosis, but the possibility of Pancreaticocolonic fistula should always be kept in mind and searched for the diagnosis of pancreaticocolonic fistulas.


Khaled E Elshaar, Hamada A Alwakeal, Alaa A Hakami, Ahmed M Osman, Laila H AbuAleid, Mohammed A Abdulmughni, Shaima A Maghadi

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