Emphysematous pancreatitis. A rare cause of fulminant multiorgan failure

[Voor]

#Emphysematouspancreatitis

Emphysematous pancreatitis is a rare and life-threatening form of acute pancreatitis occurring mostly in debilitated patients with mellitus diabetes, chronic kidney disease, cardiovascular disease or others causes of immunocompromise.

It is characterized by the presence of gas formation within and around the pancreas parenchyma at the time of the diagnosis but also in the peripancreatic spaces. Abdominal (CT) is considered as the best imaging modality to detect abnormal air bubbles with both high sensibility and sensitivity.

Pancreatic parenchymal necrosis is variable and better seen on enhanced CT images appearing as hypodense areas. The two main causes of pancreatic gas are infection by Gram-negative organisms and enteropancreatic fistula. In our case, the two mechanisms could be associated because of the presence of air into the main pancreatic duct. Moreover, the presence of E. aerogenes in blood cultures suggested primary infection as an aetiological factor.

The short time between the beginning of the symptoms and the development of gas in the pancreatic parenchyma in our case was unusual. Indeed, infections develop mostly during the first 2 or 3 weeks of the course of acute pancreatitis. Polymicrobial infection is frequent, the most common organisms being Escherichia coli, Klebsiella, Pseudomonas and Enterobacter. Image-guided fine needle aspiration is necessary for microbiological analysis. Gas-forming infections have been also described in several others organs such as cholecystitis, gastritis, pyelonephritis, cystitis or Fournier gangrene.

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[wolfgang]

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[Voor]

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