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The barium enema demonstrated extravasations of contrast from the transverse colon near the splenic and hepatic flexures (fig. 2 of the question). Exploratory laparotomy was performed on the 19th day of admission and revealed transverse colon perforations at hepatic and splenic flexures, and an abscess over the pancreatic body and tail with extension to the retroperitoneal space. Pancreatic necrosectomy, drainage of the abscess, and a diverting loop ileostomy without colonic resection were performed. The patient had an uneventful postoperative course and was discharged in stable condition after removal of all the drains, with a total hospital stay of 50 days. Follow-up CT and barium enema 9 months after surgery showed complete resolution of the abscess and colon perforation.

Colonic perforation is a rare complication of acute pancreatitis and may be life-threatening. Incidences ranging from 1% to 3.7% have been reported, with a higher risk in patients with necrotising pancreatitis.14 Fistulisation usually occurs not during the early phase of acute pancreatitis but rather as a late consequence of pancreatic pseudocyst and/or pancreatic abscess.3 4 Laparotomy followed by colectomy has been proposed in the treatment of these patients, but the prognosis is poor, with high mortality and morbidity, especially for elderly patients.5 6 Herein our patient received an alternative treatment with a satisfactory recovery.

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