Acute Pancreatitis: A Rare Post-Colonoscopy Sequela

Abstract

Abdominal pain is a common but benign symptom after colonoscopy. We report a case of acute pancreatitis that occurred just after an elective screening colonoscopy; this is a rare event with very few reported cases. A healthy, asymptomatic male underwent screening colonoscopy at our center and developed abdominal pain and emesis after the procedure. An abdominal X-ray ruled out perforation but laboratory tests revealed elevated levels of amylase and lipase. The patient had no etiological risk factors for pancreatitis. The presumed mechanism of pancreatitis in this case is mechanical and pressure trauma from excessive insufflation, external abdominal pressure, and repeated withdrawal of the colonoscope due to tight angulation of the splenic flexure, a structure that is in close proximity to the pancreatic tail. Acute pancreatitis should be considered in the differential diagnosis of patients who present with abdominal pain after colonoscopy once more common etiologies have been excluded.

Keywords: Pancreatitis; Post colonoscopy; Splenic flexure.

Fig. 1.

A erect abdominal X-ray demonstrating a distended splenic flexure (blue arrow) and absence of free air under diaphragm.

Fig. 2.

Contrast-enhanced computed tomography of the abdomen demonstrating a bulky body and tail of the pancreas with mild peripancreatic fat stranding, findings that are consistent with acute pancreatitis (blue arrow).