Post-colonoscopy pancreatitis: a case report and a systematic review of the literature.

Abstract

Background: Colonoscopy represents a commonly performed endoscopic procedure for the study of large bowel. Even though, colonoscopy is considered a safe and well-tolerated procedure, in the literature, it has also been related with in a few cases of acute pancreatitis.

Methods: A systematic PubMed and Scopus search was conducted, a propos of a case report.

Results: Twelve patients were included from 11 case reports. The mean age of the patients was 57.4 years (range: 25 - 84). None of the included patients had a history of cholelithiasis or alcoholism. The principal indication for colonoscopy was cancer/polyp surveillance (7 out of 12, 58.3%). Polypectomy was performed in 9 patients (75%). In 4 out of 12 cases (33.3%) the procedure of colonoscopy was characterised as difficult and external manipulation was necessitated. The mean onset of symptoms was 8 hours after colonoscopy (range: 2 - >24). Hospitalization was necessary in 9 out of 12 patients (75%). Regarding the location of the pancreatitis, body/tail (3 out of 12, 25%), body (4 out of 12, 33.3%) and tail (4 out of 12, 33.3%) were most affected. The median duration of symptoms was 7 days (range: 3-12). No complications were reported. The mean follow-up period of the included patients was 15 months (range: 3-36). No fatalities were reported.

Conclusion: Post-colonoscopy pancreatitis is an extremely rare complication of colonoscopy. After having excluded a surgical emergency, acute pancreatitis should be taken into consideration, especially when endoscopy is technically challenging. Conservative management is indicated in these cases, while no serious sequels have been reported in the literature.