The authors present an additional case of emphysematous necrotizing pancreatitis caused by Escherichia coli. Emphysematous necrotizing pancreatitis represents a rare and potentially life-threatening infection and is characterized by gas formation within or around the pancreas. A 26-year-old man presented with severe upper abdominal pain and vomiting, 7 hours from onset. Acute pancreatitis was initially diagnosed based on high amylase level, abdominal ultrasonography and primary CT scan. On the 7th day he developed fever, increasing abdominal pain and shortness of breath. On the second abdominal CT scan, the pancreatic bed was filled with gas. The diagnosis of emphysematous necrotizing pancreatitis was confirmed at laparotomy. The patient was treated successfully by extensive pancreatic necrosectomy, open packing and scheduled repeated debridements. Culture from the lesser sac, and retroperitoneal space, examined for aerobes and anaerobes, revealed growth of Escherichia coli. The authors analyze and discuss pathogenesis, diagnosis and treatment of emphysematous necrotizing pancreatitis. Based on the available data and this case, early surgical debridement and appropriate antibiotics appear to be the preferred treatment.