Gastrointestinal complications in acute and chronic pancreatitis

Abstract

Pancreatitis is one of the important medical conditions. Gastrointestinal (GI) complications of pancreatitis are important and lead to significant morbidity and mortality. Diagnosis of these complications is difficult and may require a strong clinical suspicion coupled with various imaging features. This review provides an extensive update of the whole spectrum of GI complication of pancreatitis, both acute and chronic, from inflammation, ischemia, and necrosis to obstruction, perforation, and GI fistulae. The focus is on the clinical and imaging features of this less commonly described aspect of pancreatitis.

Keywords: acute pancreatitis; bowel complications; chronic pancreatitis; gastrointestinal fistula.

Figure 1

Intraoperative image of a patient with colonic necrosis.

Figure 2

Intraoperative image of a patient with gastric perforation. Ryle's tube is seen protruding out of the perforation (arrow).

Figure 3

Endoscopic images showing cystocolonic (a, arrow) and cystogastric fistula (b, arrow).

Figure 4

Intraoperative image of a patient with cystoenteric fistula (arrow) with proximal jejunum.

Figure 5

Axial CT image shows dilatation of multiple small bowel loops with air fluid levels (short arrows). Also note the thickening of fascia bilaterally (arrows).

Figure 6

Axial CT shows features of groove pancreatitis in the form of cystic lesion in the medial wall of the second part of the duodenum (arrow) and pancreatic calcifications (short arrow).