Clostridium perfringens infection of pancreatic necrosis: absolute indication for early surgical intervention.

It is generally accepted that the surgical treatment of pancreatic necrosis should be delayed as long as possible and after there is laboratory confirmation of infection, determined by image guided fine-needle aspiration. Two cases of severe necrotizing pancreatitis are presented where gas developed in the pancreatic bed, detected by CT scanning, within 2--4 days of the onset of symptoms. Bacteriology studies showed clostridium perfringens and other gram negative flora. The presence of retroperitoneal gas in this context is an absolute indication for early surgical intervention.