Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 14, 2024; 30(46): 4929-4936
Published online Dec 14, 2024. doi: 10.3748/wjg.v30.i46.4929
Emphysematous pancreatitis: Diagnosis, treatment, and prognosis
Li-Jun Cao, Zhong-Hua Lu, Pin-Jie Zhang, Xiang Yang, Wei-Li Yu, Yun Sun
Li-Jun Cao, Zhong-Hua Lu, Pin-Jie Zhang, Xiang Yang, Wei-Li Yu, Yun Sun, The First Department of Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
Co-first authors: Li-Jun Cao and Zhong-Hua Lu.
Author contributions: Cao LJ and Lu ZH contributed equally to this study, designing the research and overseeing data collection; Zhang PJ was responsible for data analysis and interpretation; Yang X participated in the patient management and provided clinical insights; Yu WL contributed to the molecular and genetic studies; Sun Y, as the corresponding author, supervised the entire study process, coordinated among the different departments, and was involved in writing and revising the manuscript; All authors reviewed and approved the final manuscript.
Supported by Clinical Research Cultivation Program at The Second Affiliated Hospital of Anhui Medical University, No. 2021LCYB12; The Support Program for Elite Young Talents in Colleges and Universities of Anhui Province, No. gxyq2022006; The National Natural Science Foundation Incubation Program of The Second Affiliated Hospital of Anhui Medical University, No. 2022GMFY09 and No. 2022GMFY10; The Provincial Quality Engineering Project of Higher Education Institutions of Anhui Province, No. 2022jyxm750; and Natural Science Research Project of Colleges and Universities of Anhui Province, No. 2023AH053168, No. 2024AH050800 and No. 2024AH040107.
Institutional review board statement: The study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of the Second Affiliated Hospital of Anhui Medical University (Approval No. YX2023-136).
Informed consent statement: Written informed consent was obtained from all participants involved in the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Data supporting the results of this study are available from the corresponding author upon reasonable request at sunyun9653@126.com.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yun Sun, MD, Chief Physician, The First Department of Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Hefei 230601, Anhui Province, China. sunyun9653@126.com
Received: September 9, 2024
Revised: September 27, 2024
Accepted: October 29, 2024
Published online: December 14, 2024
Processing time: 72 Days and 22.5 Hours
Abstract
BACKGROUND

Emphysematous pancreatitis (EP) is a rare, severe form of acute necrotizing pancreatitis characterized by gas in pancreatic or peripancreatic tissue, with a high mortality rate.

AIM

To assess the diagnosis, treatment, and outcomes of EP through a series of case studies.

METHODS

This case series was conducted in intensive care units at the Second Affiliated Hospital of Anhui Medical University. Patients were included if they were diagnosed with pancreatic necrosis and gas via computed tomography from June 2018 to June 2024. Patients were categorized into early and late EP groups based on the timing of the appearance of the bubble sign and into extensive and common types based on the distribution range of the bubble sign. The data recorded included sex, age, aetiology, Acute Physiology and Chronic Health Evaluation II score, Sequential Organ Failure Assessment score, Bedside Index for Severity in Acute Pancreatitis score, subtype, gas distribution extent, aetiological diagnostic basis, pathogen categories, intervention measures, and prognosis.

RESULTS

Among the 15 patients, 66.7% had a biliary aetiology and extensive type of EP, 47.1% had early-onset EP, and 73.3% had confirmed aetiological evidence [6 based on bacterial culture, 4 based on both routine culture and next-generation sequencing (NGS), and 1 solely based on NGS]. The common pathogens were Escherichia coli and Klebsiella pneumoniae. Six patients survived. Among the 2 patients who did not undergo percutaneous drainage or surgical treatment, 1 survived. Of the 6 patients who underwent percutaneous drainage, 2 survived, 2 survived after subsequent surgery, and 2 died without surgery. Among the 6 patients who underwent surgery alone, 5 died and 1 survived. Among the early-onset EP patients, 4 survived; among the late-onset EP patients, 2 survived. Among the common EP types, 4 survived; among the extensive EP types, only 1 survived.

CONCLUSION

The mortality rate among patients with EP is considerable, and NGS enhances pathogen identification accuracy. Despite the debate on conservative vs surgical management, the STEP-UP strategy remains viable. Aggressive antimicrobial therapy, early percutaneous catheter drainage, and other minimally invasive interventions, along with delayed surgical intervention, may improve patient prognosis.

Keywords: Emphysematous pancreatitis; Diagnosis; Treatment; Prognosis; Next-generation sequencing

Core Tip: Emphysematous pancreatitis (EP) is a rare and severe condition with high mortality. This study highlights the role of next-generation sequencing in improving pathogen identification and emphasizes early percutaneous drainage, aggressive antimicrobial therapy, and minimally invasive interventions. Delayed surgery, when necessary, may improve outcomes, especially in early-onset and common-type EP patients.