title: Colonic involvement in acute pancreatitis. A retrospective study of 16 patients.
abstract: BACKGROUND
  Diagnosis of colonic pathology complicating acute pancreatitis is difficult. Several pathogenetic mechanisms have been proposed. The treatment of choice is resection of the affected segment. Current theories on diagnosis, pathogenesis, and treatment were reviewed.
  
  
  METHODS
  Retrospectively, 16 patients with severe acute pancreatitis and colonic complications (1988-2001) were included. Preoperative CT scans and specimens of removed colonic segments were reviewed by a blinded radiologist and pathologist respectively.
  
  
  RESULTS
  Sixteen patients underwent partial colectomy for suspected imminent or overt perforation, based on the outer aspect of the colon. Four patients had a macroscopic perforation during surgery. Retroperitoneal spread of the necrotizing process to the colon was seen in all 10 reviewed CT scans. All 14 microscopically examined specimens showed fat necrosis and pericolitis. Of these, 4 had ischemia and 6 showed subserosal hemorrhage. Eight specimens had intact mucosa, submucosa and smooth muscle layers. Eleven patients died. Secondary anastomosis in surviving patients did not induce further mortality.
  
  
  CONCLUSIONS
  Spread of pancreatic enzymes and necrosis is the major cause for colonic pathology in acute pancreatitis. Outside inspection of the colon during surgery is unreliable to detect ischemia or imminent perforation. To prevent colonic complications during follow-up, low-threshold colonic resection seems justified.
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: L P
authors.initials: LP
authors.lastname: Van Minnen
authors.forename: M G H
authors.initials: MG
authors.lastname: Besselink
authors.forename: K
authors.initials: K
authors.lastname: Bosscha
authors.forename: M S
authors.initials: MS
authors.lastname: Van Leeuwen
authors.forename: M E I
authors.initials: ME
authors.lastname: Schipper
authors.forename: H G
authors.initials: HG
authors.lastname: Gooszen
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D003082:Colectomy; D003106:Colon / Q000473:pathology; D003108:Colonic Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D003113:Colonoscopy; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010179:Pancreas / Q000000981:diagnostic imaging / Q000201:enzymology; D010195:Pancreatitis / Q000150:complications* / Q000601:surgery; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed