Abstract
The case in question involved a 67-year-old male. Due to diabetes and high blood pressure, the patient was undergoing internal medical treatment. The patient habitually consumed alcohol and had recently increased his intake. In the course of one evening, the patient became aware of upper abdominal pain and was referred to our hospital by a local physician the following morning. En route to hospital, the patient presented with shock, respiratory failure and systemic inflammatory response syndrome (SIRS). Tenderness and muscular defense were observed in the upper abdomen. Fat necrosis of the transverse mesocolon, inflammation and an extensive retroperitoneal space extending to the inferior pole of the right kidney and emphysema in the omental sac were observed on the CT imaging from the previous physician. Three prognostic factors and CT Grade 2 were determined according the criterion for determination of the severity of acute pancreatitis. The imaging showed no perforation in the upper gastrointestinal tract and a diagnosis of sever acute pancreatitis complicated by emphysema was reached, prompting the performance of an emergency surgical procedure. The findings of the procedure revealed peripancreatic fat necrosis, infectious effusion and pneumoretroperitoneum. Procedures performed included drainage of the omental sac and pancreatic bed. Necrotic tissue and blood cultures revealed klebsiella oxytoca. The post-operative progress was smooth and the patient was transferred to the care of a local physician on the 59th day after surgery. Reports of acute pancreatitis complicated by emphysema from the early stages of the appearance of symptoms are rare and this case is reported together with a limited review of the literature.
