Necrotising emphysematous pancreatitis

Case contributed by Dr Ian Bickle

Presentation

50 year-old admitted with abdominal pain. Clinical and laboratory diagnosis of gallstone pancreatitis. Initial CT one week into admission. Second CT a period or more than one week later.

Patient Data

Age: 50
Gender: Female

Dual phase pancreas CT study:  The pancreas is enlarged and oedematous. There is only a small amount of enhancing parenchymal tissue remaining in the distal body/tail; the remainder of the pancreas is necrotic.

Extensive peripancreatic inflammatory change.  Upper abdominal peritoneal free fluid.

CT

CT repeated more than a week later due to clinical deterioration.

Multiple foci of gas in the necrotic pancreas, with a large collection, containing both fluid and gas anterior to the body of the pancreas.

Case Discussion

This case illustrates a severe acute pancreatitis.  

Almost complete necrosis of the pancreas occurred as one of the recognised complications, with developed further into a necrotising pancreatitis and then emphysematous pancreatitis.

Pancreatic necrosectomy was performed as a last resort - although initially successful the patient died 2 weeks later with rerespiratory complications

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Case information

rID: 25727
Case created: 5th Nov 2013
Last edited: 4th Mar 2016
Inclusion in quiz mode: Included

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