Successful outcome with conservative management of emphysematous pancreatitis

Surgery is the mainstay treatment of emphysematous pancreatitis (EP). The aim of the present study was to assess the outcomes of patients with EP managed nonsurgically.

The patients with EP without organ dysfunction were managed nonsurgically with antibiotic therapy, nutritional support, and if required radiological drainage. The main outcome measure was survival.

Nine patients were diagnosed with EP. They had computed tomographic severity index of 10, APACHE score of 11 (±3.4), and Ranson's score of 4.2 (±1.2) in the first 24-48 h. All had monomicrobial infection of the pancreatic necrosis (Escherichia coli in 4/9, Pseudomonas aeruginosa in 3/9, and Klebsiella pneumoniae in 2/9 patients). All these patients were managed with antibiotics as per sensitivity reports (piperacillin-tazobactum in 5/9, imipenem in 3/9, and ciprofloxacin-metronidazole in 1/9 patients) and nutritional support. Seven of nine patients improved within 1 week of starting antibiotics. Two patients required percutaneous catheter drainage in addition. One of the patients had progressive organ dysfunction and was subjected for surgery. All 8/9 patients who were managed conservatively survived (89 % survival). The only patient who underwent surgery expired (11 % mortality).

In EP without organ dysfunction, a trial of conservative management may be successful.