Necrotizing pancreatitis complicated by retroperitoneal emphysema: two case reports

Abstract

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.

Inguinal and Perineal Necrotizing Fasciitis, A Rare Clinical Manifestation of Necrotizing Pancreatitis: Two Case Reports

“…Serum CRP level and severity of acute pancreatitis have well correlation [3]. Necrotizing pancreatitis is seen in approximately10%-20% of patients with acute pancreatitis [5]. Severe necrotizing pancreatitis has a 20% and 40% mortality rate in patients with sterile necrosis and infected necrosis with multi-organ failure, respectively [6].…”

Features of Antibiotic Therapy in Patients With a Complicated Course of Acute Pancreatitis

“…There have also been studies dedicated to the study of Helicobacter pylori (HP), as one of the possible etiopathogenetic factors of HP and its complications [4]. At the same time, it should be noted that antibiotic prophylaxis, routine antifungal prophylaxis, and the use of probiotics are not recommended [5]. However, some researchers suggest that prophylactic administration of antibiotics can prevent the development of infectious complications in patients with sterile pancreatic necrosis [6].…”