[Emphysematous pancreatitis improved by conservative treatment: a case report]

Area of Science:

• Gastroenterology
• Radiology
• Surgical Pathology

Background:

• Emphysematous pancreatitis is a rare and severe subtype of necrotizing pancreatitis.
• It is characterized by the presence of gas within the pancreatic tissue and surrounding structures, often leading to retroperitoneal emphysema.
• This condition is associated with a poor prognosis if not diagnosed and treated promptly.

Purpose of the Study:

• To report a case of emphysematous pancreatitis diagnosed via computed tomography (CT) and treated successfully.
• To highlight the diagnostic challenges and management strategies for this rare clinical entity.
• To emphasize the importance of early recognition and intervention in improving patient outcomes.

Main Methods:

• A 74-year-old male presented with upper abdominal pain.
• Computed tomography (CT) scan revealed pancreatic enlargement, increased peripancreatic fat density, and retroperitoneal emphysema, indicative of emphysematous pancreatitis.
• Upper gastrointestinal endoscopy excluded gastrointestinal perforation.
• Treatment included fasting, fluid replacement, antibiotics, and total parenteral nutrition, followed by endoscopic lithotripsy for a common bile duct stone.

Main Results:

• The patient's condition initially showed temporary encapsulation but eventually improved with the implemented treatment regimen.
• A common bile duct stone was identified and successfully treated with endoscopic lithotripsy.
• The diagnostic findings on CT were consistent with acute pancreatitis-induced retroperitoneal emphysema.

Conclusions:

• Emphysematous pancreatitis requires early diagnosis, including the exclusion of gastrointestinal perforation.
• Prompt administration of antibiotics and consideration for drainage are essential components of management.
• While rare and prognostically challenging, timely and appropriate medical and interventional strategies can lead to patient improvement.