emphysematous pancreatitis

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.


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.


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
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