Emphysematous pancreatitis is an unusual complication of acute pancreatitis caused by necrotising infection of the pancreas. It is associated with gas-forming bacteria and characterized by the presence of gas within or around the pancreas.
Infection with gas-forming bacteria such as Escherichia coli, Clostridium perfrigens, Staphylococcus sp, Streptococcus sp, Klebsiella sp and Pseudomonas sp. Gas associated with infection is generally thought to consist of carbon dioxide and nitrogen secondary to the fermentation of glucose by some species of bacteria.
Computed tomography is the imaging modality of choice because of its sensitivity and specificity in detecting gas bubbles.
Treatment and prognosis
This condition carries a high mortality rate. Percutaneous drainage of the fluid collection and, if there is no clinical response to support measures, surgical resection of the infected necrotic tissue.
- atmospheric air introduced by recent instrumentation or surgery (e.g. post ERCP)
- enteric fistula formation and reflux from the adjacent hollow viscus
- cystic neoplasm (cystic pancreatic mass differential diagnosis)
- solid neoplasm
- nonepithelial pancreatic neoplasms
pancreatitis (mnemonic for the causes)
- gallstone pancreatitis
- interstitial oedematous pancreatitis
- necrotising pancreatitis
- haemorrhagic pancreatitis
- revised Atlanta classification of acute pancreatitis
- chronic pancreatitis
- Ascaris-induced pancreatitis
- tropical pancreatitis
- autoimmune pancreatitis
- emphysematous pancreatitis
- hereditary pancreatitis
- pancreatitis associated with cystic fibrosis
- segmental pancreatitis
- acute pancreatitis
- pancreatic atrophy
- pancreatic lipomatosis
- pancreatic trauma
- 1. Kvinlaug K, Kriegler S, Moser M. Emphysematous pancreatitis: a less aggressive form of infected pancreatic necrosis?. Pancreas. 2009;38 (6): 667-71. doi:10.1097/MPA.0b013e3181a9f12a - Pubmed citation
- 2. Wig JD, Kochhar R, Bharathy KG et-al. Emphysematous pancreatitis. Radiological curiosity or a cause for concern?. JOP. 2008;9 (2): 160-6. Pubmed citation