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Article
June 1984

Massive Rectal Bleeding From Colonic Fistula in Pancreatitis

Author Affiliations

From the Department of Surgery, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC.

Arch Surg. 1984;119(6):732-735. doi:10.1001/archsurg.1984.01390180094016
Abstract

• Two cases of massive hematochezia from pancreatitis-associated colonic fistulae occurred. Diagnosis was made by arteriography; prompt surgical intervention ensued and both patients recovered. This rare complication of pancreatitis should be considered in every patient with rectal bleeding and a history consistent with pancreatitis, especially when an abdominal mass is present. Contrast enema examinations may help to make the diagnosis, but visceral arteriography is preferred because it defines the source of bleeding and guides the operative plan. The minimal surgical treatment consists of ligating bleeding vessels, debriding necrotic tissue, widely draining the peripancreatic space, and creating a totally diverting colostomy. All involved organs should be resected when technically feasible, since this eliminates abnormal tissue and minimizes the chances that hemorrhage will occur.

(Arch Surg 1984;119:732-735)

References
1.
Jacobs ML, Daggett WM, Civetta JM, et al:  Acute pancreatitis: Analysis of factors influencing survival . Ann Surg 1977;185:43-51.Article
2.
Marks IN, Banks S, Louw JH, et al:  Peptic ulceration and gastrointestinal bleeding in pancreatitis . Gut 1967;8:253-259.Article
3.
Banks PA: Pancreatitis . New York, Plenum Medical Book Co, 1979, pp 133-134.
4.
Berne TV, Edmondson HA:  Colonic fistulization due to pancreatitis . Am J Surg 1966;111:359-363.Article
5.
Morton J:  Acute pancreatitis . Surgery 1945;17:475-491.
6.
Gatch WD, Brickley RA:  Perforation of colon following acute necrosis of pancreas: Report of three cases . Arch Surg 1951;63:698-701.Article
7.
Breitenecker R:  Fatal gastrointestinal hemorrhage due to chronic relapsing pancreatitis: Report of two cases—one with abscess and one with pseudocyst formation . N Engl J Med 1959;260:1167-1169.Article
8.
Howard JM, Jordan GL Jr: Surgical Diseases of the Pancreas . Philadelphia, JB Lippincott Co, 1960, p 111.
9.
Lerner S, Zuflacht JJ, Zola SP:  Gastrocolic fistula complicating acute recurrent pancreatitis . Am J Gastroenterol 1964;41:537-540.
10.
Steedman RA, Doering R, Carter R:  Surgical aspects of pancreatic abscess . Surg Gynceol Obstet 1967;125:757-762.
11.
Sahebjami H, Gillespie L, Ferris PJ, et al:  Rectal bleeding as the presenting symptom of acute pancreatitis . Am J Gastroenterol 1970;54: 388-394.
12.
Greenstein A, DeMaio EF, Nabseth DC:  Acute hemorrhage associated with pancreatic pseudocysts . Surgery 1971;69:56-62.
13.
Lefrak EA, Korompai FL:  Erosion of splenic artery and colon by pancreatic pseudocyst . Tex Med 1974;70:79-81.
14.
Mason HDW, Forgash A, Balch HH:  Intestinal fistula complicating pancreatic abscess . Surg Gynecol Obstet 1975;140:39-43.
15.
Christensen NM, Demling R, Mathewson C Jr:  Unusual manifestations of pancreatic pseudocysts and their surgical management . Am J Surg 1975;130:199-205.Article
16.
Stabile BE, Wilson SE, Debas HT:  Reduced mortality from bleeding pseudocysts and pseudoaneurysms caused by pancreatitis . Arch Surg 1983;118:45-51.Article
17.
Abcarian H, Eftaiha M, Kraft AR, et al:  Colonic complications of acute pancreatitis . Arch Surg 1979;114:995-1001.Article
18.
Thompson WM, Kelvin FM, Rice RP:  Inflammation and necrosis of the transverse colon secondary to pancreatitis . Am J Roentgenol 1977;128:943-948.Article
19.
Bivins BA, Sachatello CR, Chuang VP, et al:  Hemosuccus pancreaticus (hemoductal pancreatitis): Gastrointestinal hemorrhage due to rupture of a splenic artery aneurysm into the pancreatic duct . Arch Surg 1978;113:751-753.Article
20.
Sbrocchi RD, Anderson MC: Erosion of adjacent organs by pancreatic pseudocysts. Read before the Southeastern Surgical Congress, Atlanta, April 25, 1983.
21.
Stanley JC, Frey CF, Miller TA, et al:  Major arterial hemorrhage: A complication of pancreatic pseudocysts and chronic pancreatitis . Arch Surg 1976;111:435-440.Article
22.
Gadacz TR, Trunkey D, Kieffer RF Jr:  Visceral vessel erosion associated with pancreatitis: Case reports and a review of the literature . Arch Surg 1978;113:1438-1440.Article
23.
Corlette MB Jr, Lynch JA:  Pancreatitis presenting as colonic fistula . Arch Surg 1972;104:708-709.Article
24.
Katz P, Dorman MJ, Aufses AH Jr:  Colonic necrosis complicating postoperative pancreatitis . Ann Surg 1974;179:403-405.Article
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