Background and Aims: Emphysematous pancreatitis (EP) is regarded as a rare form of necrotizing pancreatitis, with a high mortality. However, it has not been definitely classified so far, and also no consensus on its treatment protocol has been reached at home and abroad. Here, the authors summarize the clinical features, pathogenesis, diagnosis and treatment as well as outcomes of 3 cases of EP, so as to provide help for the clinical diagnosis and treatment of this condition in future. 
Methods: The clinical data of 3 patients admitted and diagnosed with EP were retrospectively analyzed. The relevant literature was reviewed and discussed. 
Results: Case 1 was a 72-year-old male patient who was admitted due to abdominal pain for 12 h and abdominal CT revealed the signs of acute pancreatitis. The patient developed a high-grade fever on the 5th day of admission, and reexamination abdominal CT on the that day showed pancreatic necrosis and diffuse gas shadows in the peripancreatic region, and then, an emergency peripancreatic necrosectomy was performed. Massive retroperitoneal hemorrhage occurred on the 28th day after operation, and the patient was discharged on that day after failure of conservative treatment and died on the same day. Case 2 was a 70-year-old woman who was admitted for severe abdominal pain for 1 d, and presented with septic shock on admission. CT scan on the admission day showed pancreatitis complicated with gas collections in the retroperitoneal space. Emergency laparoscopic exploration and converted open incision of the pancreatic capsule for decompression plus abdominal drainage was performed. The shock status continued to worsen and multiple organ dysfunction appeared which could not be corrected after operation. The patient was discharged on her own request 4 d after operation and died on the same day. Case 3, 71-year-old man, was hospitalized for abdominal pain for 20 h. CT scan showed acute pancreatitis without retroperitoneal gas. On the 9th day of admission, reexamination CT showed blurred contours of the pancreas and gas collections in the peripancreatic region, and percutaneous catheter drainage (PCD) was performed. On the 25th day of admission, massive retroperitoneal hemorrhage occurred, and interventional embolization was performed. One month after admission, laparotomy necrosectomy plus transverse colostomy was performed, and the patients recovered and was discharged from hospital 30 d after surgery. According the literature, the mortality rate of EP reached 10%–36%, and risk factors associated with mortality have not been well summarized. Generally, fulminant type EP was associated with a poor prognosis and subacute type EP had a relatively benign prognosis.
Conclusion: EP is a rare and life-threatening necrotizing infection of the pancreas. CT is the first choice for diagnosis of EP. Regardless of whether for the fulminant type or the subacute type EP, active antimicrobial therapy, early percutaneous catheter drainage and other minimally invasive treatment as well as delayed surgery are helpful to improve the prognosis.