Multiple Pancreatico-colonic Fistulas, Rare presentation

Pancreaticocolonic fistula is a rare and potentially critical complication of necrotizing pancreatitis. We report a complex case of multiple Pancreaticocolonic fistulas that was successfully treated with extended left hemicolectomy. A 43 years old male patient, presented in our emergency department with epigastric pain, vomiting, diarrhea and weight loss for 4 weeks duration, with past history of acute gall stone pancreatitis 10 weeks earlier. Contrast enhanced CT abdomen showed multiple Walledoff Pancreatic Necrosis in the peripancreatic, right paracolic and left paracolic regions up to left inguinal region with extensive Pneumoretroperitoneum. The periduodenal collection caused duodenal compression. Laparotomy done for pancreatic necrosectomy, relieving the duodenal compression, and drainage of all collections. We noticed multiple Pancreaticocolonic fistulas, 5 in numbers, between the transverse and descending colon and their neighboring collections, extended left hemicolectomy done. Multiple abdominal drains had been put for continuous postoperative irrigation. The patient discharged home but after 3 months of a hectic post operative course.