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#### **3. Conclusions**

Emphysematous pancreatitis is a potentially life-threatening condition. The initial clinical manifestation may be insidious, but rapid progression to sepsis will occur in the absence of early therapeutic intervention. Conventional radiography and ultrasonography are often the initial imaging modalities used to evaluate patients with abdominopelvic complaints. These modalities should be considered complementary, each with strengths and limitations. When a differential diagnosis re-mains, CT should be considered the imaging modality of choice. CT is both highly sensitive and specific in the detection of abnormal gas and well suited to reliable depiction of the anatomic location and extent of the gas. Therefore, with regard to emphysematous pancreatitis, appropriate radiologic evaluation combined with accurate interpretation of findings will help to ensure rapid diagnosis and optimal treatment planning. In addition, knowledge of the pathophysiologic characteristics and common predisposing conditions associated with gas-forming infections of the gallbladder, stomach, pancreas, and genitourinary system will aid in further diagnostic work-up, surveillance of potential complications, and evaluation of therapeutic response. The prognosis for emphysematous pancreatitis is grave, and successful treatment requires aggressive management of the infection with systemic antimicrobial therapy and control of septic shock. Early surgical debridement is usually performed, and recovery is typically prolonged.

#### **4. Acknowledgment**

Emphysematous pancreatitis is a rare and life-threatening necrotizing infection of the pancreas – 2% of all acute necrotic pancreatitis. CT is the modality of choice for detecting parenchymal gas as well as evaluating its extent and location. Ordinarily emphysematous pancreatitis requires urgent surgical management, which in most cases is successful, at the onset of disease due to multisystem organ failure and patient instability. In cases of emphysematous pancreatitis, pancreatic necrosis is already demarcated and organized at the first week, which is enough to repeat one or two additional necrosectomies for the patient full recovery. If the patient's condition is stable, aggressive broad-spectrum antibiotic coverage, nutritional support, and routine correlation of clinical progression with radiological evaluation must be taken. As demonstrated by our experience, if the patient's condition is stable, antibiotic treatment could be undertaken without any surgical intervention despite the evidence of pancreatic infection. General physical condition of the patient is an important factor for choosing a treatment rather than bacteriological or radiological findings of the infection. Aggressive broad-spectrum antibiotic coverage, nutritional support, and routine correlation of clinical progression with radiological evaluation were assets.

#### **5. References**

Adler, D. et al. (2003). Conservative management of infected necrosis complicating severe acute pancreatitis. *American journal of Gastroenterology*, Vol. 98, No. 1, (January, 2003), pp. 98-103, ISSN 0002-9270.

Emphysematous pancreatitis is a potentially life-threatening condition. The initial clinical manifestation may be insidious, but rapid progression to sepsis will occur in the absence of early therapeutic intervention. Conventional radiography and ultrasonography are often the initial imaging modalities used to evaluate patients with abdominopelvic complaints. These modalities should be considered complementary, each with strengths and limitations. When a differential diagnosis re-mains, CT should be considered the imaging modality of choice. CT is both highly sensitive and specific in the detection of abnormal gas and well suited to reliable depiction of the anatomic location and extent of the gas. Therefore, with regard to emphysematous pancreatitis, appropriate radiologic evaluation combined with accurate interpretation of findings will help to ensure rapid diagnosis and optimal treatment planning. In addition, knowledge of the pathophysiologic characteristics and common predisposing conditions associated with gas-forming infections of the gallbladder, stomach, pancreas, and genitourinary system will aid in further diagnostic work-up, surveillance of potential complications, and evaluation of therapeutic response. The prognosis for emphysematous pancreatitis is grave, and successful treatment requires aggressive management of the infection with systemic antimicrobial therapy and control of septic shock. Early surgical debridement is usually performed, and recovery is typically

Emphysematous pancreatitis is a rare and life-threatening necrotizing infection of the pancreas – 2% of all acute necrotic pancreatitis. CT is the modality of choice for detecting parenchymal gas as well as evaluating its extent and location. Ordinarily emphysematous pancreatitis requires urgent surgical management, which in most cases is successful, at the onset of disease due to multisystem organ failure and patient instability. In cases of emphysematous pancreatitis, pancreatic necrosis is already demarcated and organized at the first week, which is enough to repeat one or two additional necrosectomies for the patient full recovery. If the patient's condition is stable, aggressive broad-spectrum antibiotic coverage, nutritional support, and routine correlation of clinical progression with radiological evaluation must be taken. As demonstrated by our experience, if the patient's condition is stable, antibiotic treatment could be undertaken without any surgical intervention despite the evidence of pancreatic infection. General physical condition of the patient is an important factor for choosing a treatment rather than bacteriological or radiological findings of the infection. Aggressive broad-spectrum antibiotic coverage, nutritional support, and routine correlation of clinical progression with radiological

Adler, D. et al. (2003). Conservative management of infected necrosis complicating severe

acute pancreatitis. *American journal of Gastroenterology*, Vol. 98, No. 1, (January,

**3. Conclusions**

prolonged.

**4. Acknowledgment**

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### *Edited by Luis Rodrigo Saez*

Pancreatitis may be acute or chronic. Although they can be caused by similar aetiologies, they tend to follow distinct natural histories. Around 80% of acute pancreatitis (AP) diagnoses occur as secondary to gallstone disease and alcohol misuse. This disease is commonly associated with the sudden onset of upper abdominal that is usually severe enough to warrant the patient seeking urgent medical attention. Overall, 10 to 25% of AP episodes are classified as severe, leading to an associated mortality rate of 7 to 30%. Treatment is conservative and consists of general medical support performed by experienced teams, sometimes in ICUs. Although most cases of acute pancreatitis are uncomplicated and resolve spontaneously, the presence of complications has significant prognostic importance. Necrosis, hemorrhage, and infection convey rates of up to 25%, 50%, and 80% mortality, respectively. Other complications such as pseudocyst formation, pseudoaneurysm formation, or venous thrombosis increase morbidity and mortality to a lesser degree. The presence of pancreatic infection must be avoided.

Pancreatitis - Treatment and Complications

Pancreatitis

Treatment and Complications

*Edited by Luis Rodrigo Saez*

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