Emphysematous pancreatitis

Okamoto, Hiroshi; Kuriyama, Akira

doi:10.1136/emermed-2012-202214

Cited by 2 publications

(3 citation statements)

References 1 publication

(1 reference statement)

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Section: Discussionmentioning

confidence: 99%

“…The clinical picture is characterized by epigastric pain, nausea, vomiting, and development of multiorgan failure in severe cases[ 14 ]. Laboratory tests are non-specific; only a slight elevation of amylase and lipase can be found, and the presence of pancreatic enzyme elevation does not correlate with the severity of the disease[ 14 ]. US evaluation can hardly detect a focal emphysematous involvement and, unlike other abdominal inflammatory processes[ 15 - 22 ], cannot be used alone to achieve the correct diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…The diagnosis of PPU is made with EGD, which reveals an ulcer with the hole at the bottom[ 3 ]. Imaging, such as CECT, is useful to reveal the focal presence of gas within the pancreatic parenchyma but is less useful to reveal peptic ulcers, in particular if they are small and posterior[ 14 , 26 , 27 ]. In our case, CECT showed focal emphysema of the pancreatic head and also mild oedema of the duodenum, suggesting the intestinal origin of the gas.…”

Section: Discussionmentioning

confidence: 99%

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Emphysematous pancreatitis associated with penetrating duodenal ulcer

Tana¹,

Silingardi²,

Giamberardino³

et al. 2017

WJG

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In the “proton pump inhibitors era”, a penetrating peptic ulcer (PPU) represents an exceptional cause of abdominal pain, and was more frequently observed in the past where there was not an effective antacid treatment. Ulcer-induced pancreatitis is very rare, too, and manifests with persistent, intense pain radiating to the back. A mild to severe pancreatitis with peripancreatic fluid collection can be observed at imaging. However, only a few cases of association between PPU and emphysematous pancreatitis (EP) have been published in the literature. EP is a rare but potentially fatal form of acute necrotizing pancreatitis in which gas grows in and outside the pancreas, and typically involves the whole parenchyma in diabetic individuals.Here we report an extremely rare case of a duodenal ulcer penetrating the pancreas and complicated with EP. Unlike the classic form of EP, which involves the whole parenchyma and has a poor prognosis, we found that the emphysematous involvement of the pancreas by PPU has a benign course if a conservative therapy is promptly established. Gas is confined to the site of penetration, usually the pancreatic head, and ulcers most often involve the duodenum.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Emphysematous pancreatitis associated with penetrating duodenal ulcer

Tana¹,

Silingardi²,

Giamberardino³

et al. 2017

WJG

View full text Add to dashboard Cite

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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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Emphysematous pancreatitis

Cited by 2 publications

References 1 publication

Emphysematous pancreatitis associated with penetrating duodenal ulcer

Emphysematous pancreatitis associated with penetrating duodenal ulcer

Necrotizing pancreatitis complicated by retroperitoneal emphysema: two case reports

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