title: Pneumoretroperitoneum in two patients with Clostridium perfringens necrotizing pancreatitis.
abstract: Pancreatic gas gangrene is an uncommon and often fatal complication of acute pancreatitis, due to the sporulating anaerobe Clostridium perfringens. C. perfringens is a normal constituent of colonic flora, but infects the pancreas by either transmural spread from the colon or via the biliary tree. Only three reported cases in the world literature describe acute pancreatitis with pneumoretroperitoneum and clostridial infection. Two separate cases, at the same institution, of acute pancreatitis complicated by C. perfringens were analyzed. The records of patients were reviewed for admission history, laboratory and radiology results, intensive care support, surgical intervention, and outcome. Retroperitoneal air was visualized early in the clinical course of both patients by computed tomography. Early surgical debridement, drainage, parental antibiotics, and reexploration resulted in an uncomplicated recovery. Early computed tomography in patients with suspected necrotizing pancreatitis contributes to early intervention and may advantageously enhance survival.
authors.affiliation: Department of Surgery, The University of Texas Health Science Center, San Antonio, USA.
authors.forename: Chris M
authors.initials: CM
authors.lastname: Anderson
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Kerby
authors.forename: William B
authors.initials: WB
authors.lastname: Perry
authors.forename: Donald L
authors.initials: DL
authors.lastname: Sorrells
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents; D003015:Clostridium Infections / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D003016:Clostridium perfringens / Q000302:isolation & purification*; D003131:Combined Modality Therapy; D004322:Drainage / Q000379:methods; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005500:Follow-Up Studies; D005738:Gas Gangrene / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D007813:Laparotomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications* / Q000382:microbiology* / Q000601:surgery; D011027:Pneumoperitoneum / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents