emphysematöse Pankreatitis

Emphysematous
pancreatitis. In cranial slices we begin to appreciate the extraluminal air in the abdominal cavity.
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Emphysematous
pancreatitis. We can see the air in the pancreatic parenchyma, well-delimitated. Fat stranding at the pancreas tail and mesenteric is present. Pancreas presenting irregular and not well-defined borders.
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Emphysematous
pancreatitis. Destructuration of normal pancreactic architecture. Pancreas presenting irregular and not well-defined borders.
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Emphysematous
pancreatitis. Pancreatic head is enlarged with adjacent ill-defined peripancreatic inflammation with stranding fat and fluid collections in the peritoneal cavity. Retropneumoperitoneum at the left-anterior pararenal space.
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Emphysematous
pancreatitis. Pancreatic head is enlarged with adjacent ill-defined peripancreatic inflammation with stranding fat and fluid collections in the peritoneal cavity.
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An uncommon
complication of acute pancreatitis: emphysematous pancreatitis. Axial (a) and coronal (B) images of contrast-enhanced CT of the abdomen demonstrates intra-parenchymal gas in the body and tail of the pancreas. Inflammatory changes involving the surrounding fat of the pancreas are also seen.
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An uncommon
complication of acute pancreatitis: emphysematous pancreatitis. Axial (a) and coronal (B) images of contrast-enhanced CT of the abdomen demonstrates intra-parenchymal gas in the body and tail of the pancreas. Inflammatory changes involving the surrounding fat of the pancreas are also seen.
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An uncommon
complication of acute pancreatitis: emphysematous pancreatitis. Axial contrast-enhanced CT shows organization of the fluid and gas with wall formation - acute necrotic collection.
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Emphysematous pancreatitis is an unusual complication of acute pancreatitis caused by necrotizing infection of the pancreas. It is associated with gas-forming bacteria and characterized by the presence of gas within or around the pancreas.

Pathology

Infection with gas-forming bacteria such as Escherichia coli, Clostridium perfrigens, Staphylococcus spp, Streptococcus spp, Klebsiella spp and Pseudomonas spp. Gas associated with infection is generally thought to consist of carbon dioxide and nitrogen secondary to the fermentation of glucose by some species of bacteria.

Staging

Emphysematous pancreatitis fits into the characterization of necrotizing pancreatitis in the Balthazar score and thus corroborates the highest score in the CT severity index (CTSI).

Radiographic features

Computed tomography is the imaging modality of choice because of its sensitivity and specificity in detecting gas bubbles.

Treatment and prognosis

This condition carries a high mortality rate. Percutaneous drainage of the fluid collection and, if there is no clinical response to support measures, surgical resection of the infected necrotic tissue.

Differential diagnosis

  • atmospheric air introduced by recent instrumentation or surgery (e.g. post-ERCP)
  • enteric fistula formation and reflux from the adjacent hollow viscus
Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu emphysematöse Pankreatitis:
Pankreatitis
 
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Akute
Pankreatitis
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emphysematöse
Gastritis
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nekrotisierende
Pankreatitis
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