Necrotizing pancreatitis complicated by retroperitoneal emphysema: two case reports

Area of Science:

• Gastroenterology
• Surgical Pathology

Background:

• Emphysematous pancreatitis, characterized by acute pancreatitis with associated emphysema, is considered a severe subtype of necrotizing pancreatitis.
• While CT scans identify emphysema, its correlation with pancreatitis severity is debated.
• This condition is associated with significant morbidity and mortality.

Purpose of the Study:

• To report successful management of severe acute pancreatitis complicated by retroperitoneal emphysema.
• To highlight the role of surgical intervention in specific cases.

Main Methods:

• Two cases of severe acute pancreatitis with retroperitoneal emphysema were managed.
• Case 1 involved a 76-year-old male treated with emergent laparotomy and retroperitoneal drainage.
• Case 2 involved a 50-year-old female treated with retroperitoneal cavity lavage and drainage, with subsequent abscess management.

Main Results:

• Both patients with severe acute pancreatitis and emphysema recovered without significant postoperative complications.
• Successful outcomes were achieved with surgical drainage (lavage and drainage).
• Patients were discharged on postoperative days 18 and 108.

Conclusions:

• Acute pancreatitis with early-onset emphysema strongly suggests severe necrotizing pancreatitis.
• Surgical drainage is a crucial and recommended treatment for necrotizing pancreatitis with emphysema.