AB190. SOH21AS237. Emphysematous pancreatitis: a rare complication of gallstone pancreatitis

Background: Acute pancreatitis is a common condition with a high global burden. A recent study has estimated the global incidence of acute pancreatitis as 33.74 cases per 100,000 person years and resulting in 1.60 deaths per 100,000 person years. Acute pancreatitis presents on a spectrum, from an indolent clinical course to fulminant disease associated with systemic inflammatory response. Emphysematous pancreatitis is a severe manifestation of the disease where gas producing organisms such as Clostridia spp. and coliforms infect the pancreas and produce a profound inflammatory response.

Methods: Data extracted from medical records included presenting complaint, past medical history, imaging and laboratory data. Patient consent was obtained for the purpose of this report.

Results: We present a case of a 69-year-old male presenting with acute onset severe, abdominal pain. On admission he was febrile, hypotensive and in supraventricular tachycardia, consistent with septic shock. This required critical care admission. Intravenous antibiotics, fluid resuscitation and chemical cardioversion were initiated. Imaging revealed peripancreatic gas locules consistent with emphysematous pancreatitis. Due to the prompt imaging and supportive care this gradually resolved, however interval imaging revealed choledocholithiasis. The patient underwent endoscopic-retrograde-cholangiopancreatography with sphincterotomy and stone retrieval, which eliminated this potential aetiological factor.

Conclusions: Although rare, emphysematous pancreatitis must be considered in patients with stigmata of acute pancreatitis, as its early identification and prompt treatment are paramount in the prevention of adverse sequelae. Imaging demonstrating peri-pancreatic or intraparenchymal gas locules with radiological features of necrosis should prompt consideration of this diagnosis.

Keywords: Acute abdomen; emphysematous pancreatitis; gallstone pancreatitis; infected; pancreatitis; necrotising pancreatitis; pancreatitis