Descending colon stenosis as a complication of acute pancreatitis

The most common intestinal complications of acute pancreatitis include paralytic ileus, colonic necrosis and intestinal fistula. Large bowel obstruction has rarely been reported. We present the case of a 53-year old male patient with large bowel obstruction, which developed 2 months after his hospitalization for acute pancreatitis. As the initial conservative management was unsuccessful, he underwent laparotomy. On exploration we found a stenosing tumour located in the splenic flexure and extensive pancreatic necrosis. Hartmann’s procedure and left pancreatectomy were performed. Postoperative pathology showed chronic fibrosing inflammation of the pancreatic tail involving the splenic flexure. The postoperative period was complicated by a low-output pancreatic fistula, which healed within a month, and ureteral stones. In the second stage the patient underwent large bowel continuity restoration. We suggest in a patient with signs of bowel obstruction and recent history of acute pancreatitis that a full work-up with CT scan is invaluable before surgical treatment. This helps to choose the best treatment option and the way of surgical access, when necessary.