Clinical characteristics,microbiological spectrum and outcomes of early-onset extensive emphysematous pancreatitis

Baiqi LIU; Dingcheng SHEN; Caihong NING; Jiayan LIN; Zefang SUN; Xiaoyue HONG; Shuai ZHU; Lu CHEN; Jiarong LI; Gengwen HUANG

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Clinical characteristics,microbiological spectrum and outcomes of early-onset extensive emphysematous pancreatitis

VernacularTitle:早发广泛性气肿型胰腺炎的临床特征、病原谱及预后分析
Author: Baiqi LIU ¹ ; Dingcheng SHEN ¹ ; Caihong NING ¹ ; Jiayan LIN ¹ ; Zefang SUN ¹ ; Xiaoyue HONG ¹ ; Shuai ZHU ¹ ; Lu CHEN ¹ ; Jiarong LI ¹ ; Gengwen HUANG ¹
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1. 中南大学湘雅医院普通外科胰腺外科,湖南长沙 410008;国家老年疾病临床医学研究中心(湘雅医院),湖南长沙 410008
Publication Type:Journal Article
Keywords: Pancreatitis,Acute Necrotizing; Emphysematous Pancreatitis; Prognosis
From: Chinese Journal of General Surgery 2025;34(9):1902-1908
CountryChina
Language:Chinese
Abstract: Background and Aims:Early-onset extensive emphysematous pancreatitis(EP)is a rare but highly lethal subtype of infected pancreatic necrosis(IPN),characterized by abrupt onset and rapid deterioration.This study aimed to investigate its clinical characteristics,microbiological spectrum,treatment approaches,and outcomes to provide evidence for early identification and timely intervention.Methods:A retrospective analysis was performed on 305 IPN patients treated at Xiangya Hospital,Central South University,from January 2010 to October 2023.Eight patients who developed gas accumulation involving≥50%of pancreatic or peripancreatic necrosis within two weeks of onset were defined as early-onset extensive EP.Their clinical data were compared with those of ordinary IPN patients.Results:Early-onset extensive EP accounted for 2.6%of all IPN cases.The early-onset extensive EP group had significantly higher mortality and multiple organ failure rates compared with the ordinary IPN group(75.0%vs.24.6%and 75.0%vs.34.7%,respectively;both P<0.05).A total of 15 microbial isolates were identified from early-onset extensive EP patients,predominantly Klebsiella pneumoniae(62.5%)and Escherichia coli(37.5%).The infection rate of carbapenem-resistant Enterobacteriaceae(CRE)was markedly higher in the EP group than in the ordinary IPN group(75.0%vs.31.1%,P=0.015).Most patients were treated using a step-up approach based on percutaneous catheter drainage,with no significant difference in treatment strategy between the two groups(P=0.625).Conclusion:Early-onset extensive EP represents a rare and fulminant subtype of IPN with extremely poor outcomes.Klebsiella pneumoniae and CRE are the predominant pathogens.Early radiological evaluation and timely intervention are crucial for improving prognosis in these patients.