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I n t e r n a t i o n a l C o n f e r e n c e o n
Physicians, Surgeons and
Case Reports
November 19-20 , 2018
Par i s , France
Medical Case Reports
ISSN: 2471-8041
PSCR 2018
Context:
Pancreaticocolonic fistula is a rare and potentially critical
complication of necrotizing pancreatitis. We report a complex case of multiple
pancreaticocolonic fistulas that was successfully treated with extended left
hemi colectomy.
Case Report:
A 43 years old male patient, presented in our emergency
department with epigastric pain, vomiting, diarrhea and weight loss for 4
weeks duration, with past history of acute gall stone pancreatitis 10 weeks
earlier. Contrast enhanced CT abdomen showed multiple walled-off pancreatic
necrosis in the peripancreatic, right paracolic and left paracolic regions up to
left inguinal region with extensive pneumoretroperitoneum. The periduodenal
collection caused duodenal compression. Laparotomy done for pancreatic
necrosectomy, relieving the duodenal compression, and drainage of all
collections. We noticed multiple pancreaticocolonic fistulas, 5 in numbers,
between the transverse and descending colon and their neighbouring
collections, extended left hemicolectomy done. Multiple abdominal drains had
been put for continuous postoperative irrigation. The patient was discharged
home but after 3 months of a hectic post-operative course. To the best of our
knowledge, this is the first case to be reported in the literature with multiple
walled-off pancreatic necroses associated with multiple pancreaticocolonic
fistulas (5 in numbers) in both transverse and descending colon.
Conclusion:
Necrotizing pancreatitis is a devastating disease, the presence of
pneumoretroperitoneum does not essentially only point to infected necrosis,
but the possibility of pancreaticocolonic fistula should always be kept in mind
and searched for.
Biography
Khaled Elshaar, MBBCH, MS, MD, MRCS Eng, is a Egyptian
Consultant for General and Colo-rectal surgery with special
interests in Laparoscopic and Trauma Surgery. He has
graduated in 1995 from the Faculty of Medicine, Alexandria
University, Egypt. His Magister, MS, and Doctorate MD, were in
the field of Colo-rectal Surgery. He has worked for few years in
the AlexandriaUniversityTeachingHospitals, Egypt; latermoved
to Saudi Arabia, where he is working as a Consultant Surgeon
in King Fahd Central Hospital Jazan, since 2004 till date. He is
a Member of EAES and Egyptian society of colorectal surgery
as well as an Editorial Board Member in scientific Journals. He
had published his researches in the field of GIT surgery, and
currently, working on rare cases reports to be published.
khaledshaar2001@yahoo.comMultiple pancreaticocolonic fistulas involving the
transverse and descending colon with multiple walled-off
pancreatic necroses: reporting of a complex case treated
surgically
Khaled E Elshaar, Alaa A Hakami, Ahmed M Osman, Laila H
AbuAleid, Mohammed A Abdulmughni
and
Shaima A Maghadi
King Fahd Central Hospital, Saudi Arabia
Khaled E Elshaar et al., Med Case Rep. 2018, Volume:4
DOI: 10.21767/2471-8041-C2-005