Pneumoperitoneum Complicating Acute Pancreatitis

Pneumoperitoneum due to acute emphysematous pancreatitis has not been much described in the literature. We report a case of an elderly male, who presented to the emergency in a critical condition and was suspected as surgical acute abdomen. The chest X-ray obtained suggested a hollow viscus perforation. A contrast-enhanced computerized tomography abdomen soon after the initial stabilization, showed a bulky uncinate process and head of pancreases, with air-containing collection in the peripancreatic region and pneumoperitoneum. Broad-spectrum antibiotics and percutaneous drainage of the collection were performed under careful ultrasound surveillance. However, despite the drainage and conservative measures, he succumbed to the illness on the 5 th day of hospital stay due to multiorgan failure. Pneumoperitoneum is an emergency in the context of pancreatitis. Although imminent percutaneous drainage or necrosectomy is the ideal, the role of aggressive medical management has also been shown to be a viable option.