S3400 Acute Pancreatitis Following Routine Screening Colonoscopy

Introduction: Acute pancreatitis (AP) is the leading cause of hospitalization due to gastrointestinal causes in the United States. Gallstones and alcohol represent the most common etiologies. AP occurs at a rate of 5%-10% following endoscopic retrograde cholangiopancreatography and less commonly with upper endoscopy. Acute pancreatitis following colonoscopy is rare, limited to only a handful of cases in the literature. We report a case of mild interstitial pancreatitis following a routine screening colonoscopy. Case Description/Methods: A 75-year-old woman with history of diabetes and hypertension presented for an outpatient routine colonoscopy. Her examination was unremarkable prior to the procedure and her vital signs were within normal range. Her medications were omeprazole, letrozole, duloxetine, amlodipine, simvastatin and alendronate; all of which she has received for more than 3 years. Three sessile polyps ranging from 3-6 mm were removed with a cold snare. No electrocautery was used. Moderate diverticulosis was identified in the left colon. Following the procedure she complained of severe left upper quadrant pain. Her vital signs demonstrated tachycardia to 110 beats/minute with no hypotension or fever. In the emergency department, a complete blood count showed no leukocytosis or left shift, hemoglobin was normal. Liver enzymes were normal. Initial lipase was 749 U/L. A computed tomography of the abdomen demonstrated mild peri-pancreatic edema involving the tail of the pancreas, no cholelithiasis, and no free air. She was admitted for intravenous hydration and pain control and was discharged home in stable condition in 48 hours. She was asymptomatic on a 7-day follow-up from her procedure. Discussion: This case highlights a rare but serious complication of routine colonoscopy. Early recognition and vigilance allowed early triage and resulted in a favorable patient outcome. Inadvertent organ injury such as splenic laceration and injury, and less commonly acute pancreatitis are elements that gastroenterologists should consider in the patient with severe post-procedural pain following a colonoscopy among more common complications such as colonic perforation and post-polypectomy syndrome.