Emphysematous pancreatitis

Last revised by Reabal Najjar on 14 Feb 2023

Emphysematous pancreatitis is an unusual complication of acute pancreatitis caused by necrotizing infection of the pancreas. It is associated with gas-forming bacteria and characterized by the presence of gas within or around the pancreas 1

Infection with gas-forming bacteria such as

  • Escherichia coli

  • Clostridium perfrigens

  • Staphylococcus spp.

  • Streptococcus spp

  • Klebsiella spp.

  • Pseudomonas spp.

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 2.

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.

  • gas introduced by recent instrumentation, surgery (e.g. post-ERCP) or trauma

  • enteric fistula formation and reflux from an adjacent hollow viscus

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Cases and figures

  • Case 1: infected necrosis
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  • Case 2: near complete pancreatic necrosis
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  • Case 3: perforating into stomach
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  • Case 4
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