Emphysematous pancreatitis: a less aggressive form of infected pancreatic necrosis?

OBJECTIVE

Emphysematous pancreatitis is characterized by the presence of intraparenchymal pancreatic air in the setting of necrotizing pancreatitis. Mortality and morbidity rates approach approximately 40% and 100%, respectively. Traditionally, emphysematous pancreatitis was an indication for surgical intervention. The purpose of this review was to discuss our experience with nonoperative management of emphysematous pancreatitis.

METHODS

Between July 2005 and August 2007, 5 patients with emphysematous pancreatitis were admitted to Royal University Hospital (Saskatoon, Saskatchewan, Canada). The cases are described in the context of the current literature.

RESULTS

The 5 male patients ranged in age from 50 to 77 years. Four required at least 1 week in the intensive care unit. All 5 cases of emphysematous pancreatitis went on to be treated successfully with nonoperative management. Furthermore, after a minimum of 1-year follow-up, they remain out of hospital and continue to do well.

CONCLUSIONS

Our data suggest that emphysematous pancreatitis may be a favorable subtype of severe pancreatitis. In well-selected patients, nonoperative management with aggressive antibiotic treatment and nutritional support may suffice.