[Massive rectal hemorrhage by colonic fistulization of a pancreatitis lesion].
Rectal hemorrhage of massive proportions in 4 patients was due to vascular erosion of a necrotic pancreatitis focus, and fistulization at the splenic angle of colon. This serious complication may arise during the course of acute pancreatitis or an acute episode of chronic pancreatitis. A literature review showed 22 similar cases reported. Diagnosis is suggested by the discovery of a stenosis of colon in a case of pancreatitis, and can be confirmed by emergency arteriography or operative findings. Hemorrhage is usually from the splenic artery but erosion of a left renal artery has been described. Treatment is by embolization during angiography followed by drainage of the pancreatic necrosis and a colon bypass operation, or by splenopancreatectomy combined with colectomy. Use of these two procedures led to recovery in the 4 cases reported.
D003082:Colectomy; D003108:Colonic Diseases / Q000209:etiology*; D004621:Embolization, Therapeutic; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010185:Pancreatic Fistula / Q000209:etiology* / Q000628:therapy; D010195:Pancreatitis / Q000150:complications*; D013156:Splenectomy
Hémorragies rectales de grande abondance par fistulisation colique d'une lésion de pancréatite.