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Massive emphysematous pancreatitis associated with duodenal microperforation
Michael van der Mark1, Merwe Hartslief1
1Department of General Surgery, Cairns Hospital, Queensland, Australia.
Journal of Surgical Case Reports
|September 19, 2022
Summary
Emphysematous pancreatitis (EP), a rare condition caused by gas-forming bacteria, can arise from a penetrating ulcer. This case highlights successful surgical management of massive EP with pseudoaneurysm and duodenal microperforation.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Surgical Pathology
Background:
- Emphysematous pancreatitis (EP) is a rare, severe form of necrotizing pancreatitis.
- It often results from superinfection with gas-forming bacteria like Escherichia coli and Klebsiella pneumoniae.
- Bacterial colonization can occur via intestinal translocation, hematogenous spread, or direct seeding from a penetrating ulcer.
Observation:
- Previously reported cases of EP associated with penetrating ulcers are rare, typically showing localized gas at the fistulation site.
- This report details a unique case of massive emphysematous pancreatitis.
- The case involved a pseudoaneurysm and an associated duodenal microperforation.
Findings:
- Gas formation in EP is attributed to mixed acid fermentation by colonizing bacteria.
- This presentation involved extensive pancreatic necrosis and gas accumulation.
- The patient presented with a pseudoaneurysm and duodenal microperforation, complicating the pancreatitis.
Implications:
- This case underscores the rare but serious complication of EP secondary to penetrating ulcers.
- Successful surgical intervention was achieved in a patient with massive EP, pseudoaneurysm, and duodenal microperforation.
- The findings emphasize the importance of considering EP in necrotizing pancreatitis, especially with suspected ulcer complications, and highlight the potential for successful surgical outcomes.
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