COLONIC COMPLICATIONS OF ACUTE NECROTIZING PANCREATITIS

Among 126 patients operated upon for acute necrotizing pancreatitis in our department over a 10-year period starting in November 1979, 17 ha d a colonic resection. Colectomy was made mandatory by a necrotic or i schaemic appearance (12 cases, including 3 bowel perforations), an iso lated perforation (2 cases) or extensive fat necrosis of the pericolon ic atmosphere (3 cases). The hospital mortality was 5 out of the 17 ca ses. In 6 patients, the pathological results suggested that colonic re section was unnecessary. Since May 1988, a diverting loop ileostomy ha s been performed whenever colonic viability was found to be dubious at laparotomy. After this policy was introduced no case of secondary col onic complication was encountered. Nevertheless, there still are << ab usive >> colectomies unjustified by the pathology. Their number should be reduced by a more cautious indication of colonic resection in acut e necrotizing pancreatitis.