Necrotizing 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 years
Gender: Female
CT

One week into admission

Dual phase pancreas CT study:  The pancreas is enlarged and edematous. 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 case of acute pancreatitis.  

Almost complete necrosis of the pancreas occurred as one of the recognized complications, which developed further into necrotizing pancreatitis and then emphysematous pancreatitis.

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

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Case information

rID: 25727
Published: 5th Nov 2013
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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