Colon Involvement in Necrotizing Pancreatitis

Abstract

Objective: To investigate the incidence, risk factors, and outcomes of colon involvement in patients with necrotizing pancreatitis. Summary/Background Data: Necrotizing pancreatitis is characterized by a profound inflammatory response with local and systemic implications. Mesocolic involvement can compromise colonic blood supply leading to ischemic complications; however, few data exist regarding this problem. We hypothesized that the development of colon involvement in necrotizing pancreatitis (NP) negatively affects morbidity and mortality. Methods: Six hundred forty-seven NP patients treated between 2005 and 2017 were retrospectively reviewed to identify patients with colon complications, including ischemia, perforation, fistula, stricture/obstruction, and fulminant Clostridium difficile colitis. Clinical characteristics were analyzed to identify risk factors and effect of colon involvement on morbidity and mortality. Results: Colon involvement was seen in 11% (69/647) of NP patients. Ischemia was the most common pathology (n ¼ 29) followed by perforation (n ¼ 18), fistula (n ¼ 12), inflammatory stricture (n ¼ 7), and fulminant C difficile colitis (n ¼ 3). Statistically significant risk factors for developing colon pathology include tobacco use (odds ratio (OR), 2.0; 95% confidence interval (CI), 1.2-3.4, P ¼ 0.009), coronary artery disease (OR, 1.9; 95% CI, 1.1-3.7; P ¼ 0.04), and respiratory failure (OR, 4.7; 95% CI, 1.1-26.3; P ¼ 0.049). When compared with patients without colon involvement, NP patients with colon involvement had significantly increased overall morbidity (86% vs 96%, P ¼ 0.03) and mortality (8% vs 19%, P ¼ 0.002). Conclusion: Colon involvement in necrotizing pancreatitis is common; clinical deterioration should prompt its evaluation. Risk factors include tobacco use, coronary artery disease, and respiratory failure. Colon involvement in necrotizing pancreatitis is associated with substantial morbidity and mortality.

Colonic mucin‐2 attenuates acute necrotizing pancreatitis in rats by modulating intestinal homeostasis

“…The intestine is one of the distant organs damaged during ANP, 4,5 and intestinal barrier failure leads to the release of large amounts of intestinal cytokines and inflammatory mediators, resulting in systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) 6 . Recently, Maatman et al documented the colon involvement in ANP, which is associated with an increased incidence of organ failure, more frequent hospital readmission, and prolonged disease duration 7 . Increasing attention has been placed on improving intestinal function during AP.…”

“…6 Recently, Maatman et al documented the colon involvement in ANP, which is associated with an increased incidence of organ failure, more frequent hospital readmission, and prolonged disease duration. 7 Increasing attention has been placed on improving intestinal function during AP.…”

Response to Letter to Editor Regarding “Colon Involvement in Necrotizing Pancreatitis: Incidence, Risk Factors, and Outcomes (Ann Surg 2020 Jul 7. Online Ahead of Print; PMID: 32649468)”

“…W e really interest with a recent article by Zyromski et al, who found that colon involvement is common complications in necrotizing pancreatitis which is associated with substantial morbidity and mortality. 1 We really admire the work which was finished by the authors. However, some vital issues need to be explored and our experience remains to be shared.…”

“…Regarding our paper “Colon Involvement in Necrotizing Pancreatitis: Incidence, Risk Factors, and Outcomes” 1 we appreciate the writer's interest in our work and the opportunity to highlight a few important points from our study. Firstly, the impact of mesenteric venous thrombosis as an important contribution to colonic ischemia is frequently under looked but offers an important piece of diagnostic information in a challenging clinical circumstance.…”

Biliary Stricture After Necrotizing Pancreatitis

“…common complications in patients with NP include infection, organ failure, and pancreatic endocrine and exocrine insufficiency 1–5 . Long-term sequelae of NP are becoming better known and include complications such as disconnected pancreatic duct syndrome (DPDS) and splanchnic vein thrombosis (SVT) 4,6–9 . Rarely reported are the foregut complications from NP, which can involve the stomach and duodenum, bile duct, and pancreatic duct.…”