Colonic complications in acute pancreatitis: management experience from a single institution

Colonic complications secondary to acute pancreatitis (AP) are rare. Management of these pathologies is inconsistent and non-standardized because of their rarity. A retrospective review was performed for patients admitted to our health network with colonic complications secondary to AP from 1st January 2009 to 31st December 2023. 13 patients were admitted at Monash Health between January 2009 and December 2023 for a colonic complication secondary to AP. One had a bowel obstruction secondary to retroperitoneal compression, four had pancreatic-colonic fistulas, three had colonic infarction, two presented with colonic perforation while three presented with obstructive colonic strictures. The most common aetiology was gallstone pancreatitis (n=4). Initial management for colonic fistulas and strictures were commonly with a diverting loop ileostomy, while perforations/necrosis required emergent colectomies with or without diverting stomas. Colonic fistulas in AP can be managed safely with a diverting loop ileostomy to delay or avoid the need for a major resection during the acute phase. However, emergency colonic resection should be performed in the case of colonic perforation or necrosis and is associated with worse outcomes.