Colonic perforation secondary to post endoscopic retrograde cholangio-pancreatography severe pancreatitis: a case report on the lethal potential of neglected cholelithiasis with review of literature

A 40-year-old lady with a known history of gallstones presented with acute abdominal pain. Diagnostic imaging confirmed cholelithiasis with concomitant choledocholithiasis. She underwent a therapeutic endoscopic retrograde cholangiopancreatography for stone extraction. Her post-procedural course was complicated by the development of severe acute pancreatitis. Despite aggressive medical management, her clinical condition deteriorated rapidly. Subsequent computed tomography scans revealed extensive pancreatic necrosis and a perforation of the splenic flexure of the colon. The patient was taken for emergency surgery. An exploratory laparotomy was performed. Resection of the affected splenic flexure, a primary anastomosis, and the creation of a proximal loop ileostomy done. The patient recovered without further major complications. She was discharged in satisfactory condition with plans for ileostomy reversal later on. This case underscores the dictum that in medicine, a benign-looking pathology can have malignant consequences, demanding respect, timely intervention, and relentless monitoring.