A rare case of emphysematous pancreatitis: managing a killer without the knife

Page, Daniel; Ratnayake, Sujith

doi:10.1093/jscr/rjaa086

Cited by 2 publications

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“…The mainstay of management of necrotic emphysematous pancreatitis as per the current standard of care is endoscopic/percutaneous drainage and/or surgical necrosectomy [3,4]. However, there are certain reports mentioning successful management of emphysematous pancreatitis with conservative measures as stated by Page and Ratnayake [7]. Conservative management of emphysematous pancreatitis works along the same lines as management of acute pancreatitis with intravenous fluids, enteric feeds, and appropriate antibiotics covering the most common causative organisms [1,7].…”

Section: Discussionmentioning

confidence: 99%

“…However, there are certain reports mentioning successful management of emphysematous pancreatitis with conservative measures as stated by Page and Ratnayake [7]. Conservative management of emphysematous pancreatitis works along the same lines as management of acute pancreatitis with intravenous fluids, enteric feeds, and appropriate antibiotics covering the most common causative organisms [1,7]. New-onset diabetes mellitus is also a known complication of acute pancreatitis and a study conducted by Das et al [8] showed that patients with acute pancreatitis often develop pre-diabetes and/or diabetes mellitus after discharge from the hospital and have a greater than a two-fold increased risk of diabetes mellitus over 5 years.…”

Section: Discussionmentioning

confidence: 99%

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Emphysematous pancreatitis presenting as new-onset diabetes mellitus with multi-organ dysfunction: Managed successfully with medical management alone

Singh¹,

Ambinathan²,

Knotek³

2022

Indian J Case Reports

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Emphysematous pancreatitis is one of the rare and potentially fatal complications of acute pancreatitis. We present here the case of a 69-year-old man who presented with abdominal discomfort, vomiting, and constipation with features of sepsis due to Klebsiella pneumoniae bacteremia and new-onset diabetes mellitus. Elevated serum lipase levels and abdominal computed tomography scan showing pancreatic necrosis with air bubbles suggestive of emphysematous pancreatitis. He was managed conservatively as the surgical intervention was differed in view of unstable hemodynamics and thrombocytopenia. The entire emphysematous pancreatitis and sepsis resolved with medical management alone although surgical necrosectomy may be indicated at presentation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Emphysematous pancreatitis presenting as new-onset diabetes mellitus with multi-organ dysfunction: Managed successfully with medical management alone

Singh¹,

Ambinathan²,

Knotek³

2022

Indian J Case Reports

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Necrotizing pancreatitis complicated by retroperitoneal emphysema: two case reports

et al. 2022

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Background Emphysematous pancreatitis is acute pancreatitis associated with emphysema based on imaging studies and has been considered a subtype of necrotizing pancreatitis. Although some recent studies have reported the successful use of conservative treatment, it is still considered a serious condition. Computed tomography (CT) scan is useful in identifying emphysema associated with acute pancreatitis; however, whether the presence of emphysema correlates with the severity of pancreatitis remains controversial. In this study, we managed two cases of severe acute pancreatitis complicated with retroperitoneal emphysema successfully by treatment with lavage and drainage. Case presentation Case 1: A 76-year-old man was referred to our hospital after being diagnosed with acute pancreatitis. At post-admission, his abdominal symptoms worsened, and a repeat CT scan revealed increased retroperitoneal gas. Due to the high risk for gastrointestinal tract perforation, emergent laparotomy was performed. Fat necrosis was observed on the anterior surface of the pancreas, and a diagnosis of acute necrotizing pancreatitis with retroperitoneal emphysema was made. Thus, retroperitoneal drainage was performed. Case 2: A 50-year-old woman developed anaphylactic shock during the induction of general anesthesia for lumbar spine surgery, and peritoneal irritation symptoms and hypotension occurred on the same day. Contrast-enhanced CT scan showed necrotic changes in the pancreatic body and emphysema surrounding the pancreas. Therefore, she was diagnosed with acute necrotizing pancreatitis with retroperitoneal emphysema, and retroperitoneal cavity lavage and drainage were performed. In the second case, the intraperitoneal abscess occurred postoperatively, requiring time for drainage treatment. Both patients showed no significant postoperative course problems and were discharged on postoperative days 18 and 108, respectively. Conclusion Acute pancreatitis with emphysema from the acute phase highly indicates severe necrotizing pancreatitis. Surgical drainage should be chosen without hesitation in necrotizing pancreatitis with emphysema from early onset.

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A rare case of emphysematous pancreatitis: managing a killer without the knife

Cited by 2 publications

References 6 publications

Emphysematous pancreatitis presenting as new-onset diabetes mellitus with multi-organ dysfunction: Managed successfully with medical management alone

Emphysematous pancreatitis presenting as new-onset diabetes mellitus with multi-organ dysfunction: Managed successfully with medical management alone

Necrotizing pancreatitis complicated by retroperitoneal emphysema: two case reports

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