Gas in the pancreatic bed without abscess

A series of 259 patients from the Emory University Affiliated Hospitals with clinical suspicion of pancreatic inflammatory or neoplastic disease was reviewed. Seven of the patients had documented gas in a pancreatic mass; three of the cases were proved subsequently not to be pancreatic abscess formation. Two of the seven patients had proven fistulae from pseudocyst to bowel documented either by surgery or on an associated radiologic examination which accounted for the gas. In one additional patient, no fistula was identified at preoperative radiologic examination or at surgery. The awareness of this entity is important in the avoidance of unnecessary surgery. Since patients with spontaneous cystoenteric fistulae improve after rupture into the gastrointestinal tract, this entity should be kept in mind, particularly in the patient who is not toxic. Radiologic evaluation of the gastrointestinal tract to detect fistulous communication, percutaneous aspiration, and culture may prevent unnecessary surgery.