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Necrotizing Pancreatitis and Gas Forming Organisms

Context Acute Pancreatitis is a common disease of the gastrointestinal tract that accounts for thousands of hospital admissions in the United States every year. Severe acute necrotic pancreatitis has a high mortality rate if left untreated, and always requires surgical intervention. The timing of surgical intervention is of importance. Here we present a case of a patient with severe necrotizing pancreatitis with possible gas producing bacteria in the retroperitoneum shown on imaging and cultures. Case Report The patient is a Seventytwo- year old male presenting to the emergency department with complaining of severe epigastric pain for the past 48 hours. The labs and clinical symptoms were consistent with pancreatitis. However, the imaging showed necrotic pancreatitis that required immediate intervention. During the course of six weeks, the patient underwent numerous surgical procedures to debride the necrotic pancreas. The patient was ultimately clinically stable to be discharged and transferred to a skilled-nursing facility, but returned 3 days later with a postsurgical wound infection vs. anastomotic leak with enterocutaneous fistula. Conclusion The patient ultimately expired 7 days after his second admission to the hospital due to multi-organ failure secondary to sepsis.


Theadore Hufford, Terrence Lerner

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