Fig. 7
Necrotising AP plus retroperitoneal air in a 79-year-old male occurring 48 h after ERCP treatment of choledocholithiasis, including sphincterotomy. Contrast-enhanced CT (a, b) showed an enlarged, markedly inhomogeneous, poorly enhancing pancreas with fascial (thin arrow in a), peripancreatic and infrahepatic (+ in b) fluid, gas bubbles along the superior mesenteric vessels and in the periduodenal region. Pleural effusion was present bilaterally. Urgent laparotomic surgery confirmed severe necrotic-haemorrhagic pancreatitis. During his prolonged stay in the intensive care unit, follow-up unenhanced CT (c) showed the appearance of a vast walled-off postnecrotic collection (*)