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Emphysematous pancreatitis: classic findings
  1. Ankit Balani1,
  2. Amit Kumar Dey2,
  3. Sandhya Sarjare1,
  4. Chinky Chatur1
  1. 1Yashoda Super Specialty Hospitals, Secunderabad, Telangana, India
  2. 2Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
  1. Correspondence to Dr Amit Kumar Dey, amit5kem{at}

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A 55-year-old man with diabetes presented to our hospital with recent onset acute abdominal pain and recurrent vomiting. He was immediately admitted to the intensive care unit for ionotropic and invasive respiratory support. He had an acutely tender abdomen with distension. Haematological examination showed leucopenia (880/mm3), thrombocytopenia (64 000/mm3), elevated C reactive protein (68 mg/mL), metabolic acidosis (pH: 6.88) with a severely elevated blood lactate (14 mmol/L), estimated creatinine clearance <14 mL/min, hyperlipidaemia (1280 U/L) and serum amylase levels of 5134 U/L. Plain CT revealed extensive gas in the pancreatic bed extending into the lesser sac and adjacent retroperitoneal space (figure 1A, B). A diagnosis of acute severe emphysematous pancreatitis was made; although the patient was aggressively treated, unfortunately he died. Retrospective blood cultures were positive for Enterobacter aerogenes.

Figure 1

(A) CT image showing the presence of air lucencies in the epigastric region at the level of L1–L2 vertebral bodies, likely emphysematous pancreatitis. (B) Axial non-enhanced CT of the abdomen at the level of pancreas showing intraparenchymal air foci in the region of pancreatic head, body and tail (arrow) extending into the lesser sac and adjacent retroperitoneal space.

Learning points

  • Pancreatic bed gas typically arises from polymicrobial infections due to gas-forming organisms, such as Enterobacteriaceae or anaerobes.

  • It can also reflect fistulous communication between the pancreas and digestive tract.1

  • Emphysematous pancreatitis due to infection of pancreatic necrosis is an extremely severe condition and has a high mortality.


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  • Contributors AB contributed to conception and design, acquisition of data or analysis and interpretation of data. AKD and CC involved in drafting the article or revising it critically for important intellectual content. SS provided final approval of the version published and critical revisions. All authors agree to be accountable for the article and to ensure that all questions regarding the accuracy or integrity of the article are investigated and resolved.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.