Fulminant type of emphysematous pancreatitis has risk of massive hemorrhage

Hirotake Komatsu, Hiroshi Yoshida, Hiroki Hayashi, Naoaki Sakata, Takanori Morikawa, Tohru Onogawa, Fuyuhiko Motoi, Toshiki Rikiyama, Yu Katayose, Shinichi Egawa, Morihisa Hirota, Tooru Shimosegawa, Michiaki Unno

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Emphysematous pancreatitis (air in the parenchyma) was previously considered an indication for surgery, but some recent studies have reported good clinical outcomes with non-operative management. As a step toward establishing a better treatment strategy, we report a case of fulminant pancreatitis with massive hemorrhage into the emphysematous space. A 75-year-old man was admitted with worsening abdominal pain with obstructive jaundice and renal failure 28 h after the onset. He was diagnosed as having emphysematous pancreatitis with slight pancreatic necrosis. Despite conservative treatment with intensive care, sudden cardiac and respiratory failure occurred, and he died 53 h after onset. The autopsy findings revealed biliary sludge and massive bleeding in the retroperitoneal space around the pancreas, suggesting that temporary obstruction of the bile duct with sludge induced emphysema and the hemorrhage rapidly spread into the broadened emphysematous space. Whereas conservative management has been thought to be appropriate in selected cases of emphysematous pancreatitis, when there is pancreatic emphysema in the early phase, a fulminant course tends to develop. Since there is a risk of massive bleeding into the emphysematous space, endoscopic or invasive drainage performed to collapse the emphysematous space could benefit the outcome.

Original languageEnglish
Pages (from-to)249-254
Number of pages6
JournalClinical Journal of Gastroenterology
Issue number4
Publication statusPublished - 2011 Aug


  • Acute necrotizing pancreatitis
  • Computed tomography (CT)
  • Emphysema
  • Hemorrhagic shock

ASJC Scopus subject areas

  • Gastroenterology


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