Pancreatic gas: indication of pancreatic fistula.

Although pancreatic gas may be associated with pancreatic abscess, it was found that pancreatic gas indicates the presence of a fistula rather than abscess alone. Of 10 patients with pancreatic gas on computed tomography, fistulas were present in all. Fistulization results from pancreatic pseudocyst rupture or as a complication of phlegmonous pancreatitis. In most cases the fistula does not adequately decompress the pseudocyst or pancreatic phlegmon. In addition, fistulas may predispose to sepsis and hemorrhage. It is important to identify the presence of a pancreatic fistula since patient management may be altered.