Emphysematous Pancreatitis

 

• Severe complication of acute pancreatitis
• Pathophysiology of pancreatitis is a chain of events that result from blockage of the pancreatic duct with subsequent release of pancreatic enzymes into the interstitium of the gland
  • Most common etiologies of acute pancreatitis are cholelithiasis and alcoholism
• If necrosis occurs, it tends to occur early in course of disease
• Diagnosis depends upon clinical presentation and presence of gas in retroperitoneum
• Diagnosis of necrosis
  • Focal or diffuse
  • Well-marginated
  • Area of parenchymal non-enhancement
  • >3cm
  • Infected pancreatic necrosis recognized at helical CT as
    • Bubbles of gas within areas of pancreas
    • Or, collection of gas and tissue within the retroperitoneum

Axial, enhanced CT scans of the upper abdomen show extensive gas in the region of the body and
tail of the pancreas with infiltration of the peripancreatic fat

• E. Coli can infect necrotic pancreas
  • Produces gas in body of pancreas and retroperitoneum
• Emphysematous pancreatitis warrants
  • Early use of antibiotics
  • Percutaneous drainage of fluid collections
  • If no response
    • Surgical resection of infected necrotic tissue
• Carries grave prognosis