A 55-year-old man with diabetes presented to the hospital after having recent onset of acute abdominal pain and recurrent vomiting [Balani, et al. BMJ Case Reports. 2016; Dec 15]. He was immediately admitted to the intensive care unit for ionotropic and invasive respiratory support. He had an acutely tender abdomen with distension, and a hematologic examination revealed leukopenia (880/mm3), thrombocytopenia (64,000/mm3), elevated C reactive protein (68 mg/mL), metabolic acidosis (pH: 6.88) with a severely elevated blood lactate (14 mmol/L), estimated creatinine clearance <14 mL/min, hyperlipidemia (1280 U/L), and serum amylase levels of 5134 U/L. Plain CT showed extensive gas in the pancreatic bed that extended into the lesser sac and adjacent retroperitoneal space. The clinicians made a diagnosis of acute severe emphysematous pancreatitis. Aggressive treatment was begun, but the patient died. Retrospective blood cultures were positive for Enterbacter aerogenes. (219-6)

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