Acute pancreatitis is a commonly encountered acute inflammatory condition which involves the pancreas. It has been suggested that the distribution of necrosis and inflammation seen histologically depends on whether the pancreatitis occurs as a result of ductal obstruction or following an interruption in the supply of blood to the pancreas.
A histological review of 27 pancreata removed at post-mortem from patients dying with acute pancreatitis confirms that the distribution of inflammation seen in the pancreas is characteristic of the pathogenic mechanisms giving rise to the disease. The findings of experimental and autopsy series are reviewed and provide support for the hypothesis.
Get full access to this article
View all access options for this article.
References
1.
AcostaJ. M.RossiR.GalliD. M. (1978) Early surgery for acute gall stone pancreatitis: evaluation of a systemic approach. Surgery, 83, 367–71.
2.
AhoH. J.NevalainenT. J.AhoA. J. (1983) Experimental pancreatitis in the rat. Development of pancreatic necrosis, ischaemia and edema after intraduct sodium tanrocholate injection. Eur. Surg. Res.15, 28–36.
3.
AhoH. J.SuonpaaK.AholaR. A.NevalainenT. J. (1984) Experimental pancreatitis in the rat — Ductal factors in sodium taurocholate induced acute pancreatitis. Exp. Path.25, 73–9.
4.
ArmstrongC. P.TaylorT. V.TorranceH. B. (1985) Pressure volume and the pancreas. Gut, 26, 615–24.
5.
BerryA. R.MillarA. M.TaylorT. V. (1982) Pancreatic blood flow in experimental acute pancreatitis. Dig. Dis. Sci.27, 444–8.
6.
BroeP. J.ZuidemaG. D.CameronJ. L. (1982) The role of ischaemia in acute pancreatitis. Studies with an isolated perfused canine pancreas. Surgery, 91, 377–83.
7.
BuckspanR.WolteringE.WaterhouseG. (1984) Pancreatitis induced by intravenous infusion of a fat emulsion in an alcoholic patient. South. Med. J.77, 251–2.
8.
DeviereJ.ReuseC.AskenasiR. (1987) Ischaemic pancreatitis and hepatitis secondary to Ergotamine poisoning. J. Clin. Gastroenterol.3, 350–52.
9.
DonaldsonL. A.WilliamsR. W.SchenkW. S. (1978) Experimental pancreatitis: effect of plasma and Dextran on pancreatic blood flow. Surgery, 84, 313–21.
10.
DonaldsonL. A. (1980) Acute pancreatitis. Ischaemia or hyperaemia. Med. Hypothesis, 6, 329–36.
11.
DurringtonP. N.CairnsS. A. (1982) Acute pancreatitis: a complication of beta-blockage. Brit. Med. J.284, 1016.
12.
FariasL. R.FreyC. F.FrenchS.GuntherR. (1986) The role of ductal obstruction on the course of hemorrhagic pancreatitis in the pig. Int. J. Pancreatol.1, 51–9.
13.
FeinerH. (1976) Pancreatitis after cardiac surgery. A morphologic study. Am. J. Surg.131, 684–8.
14.
FloryC. M. (1945) Arterial occlusions produced by emboli from eroded aortic atheromatous plaques. Am. J. Path.21, 549–65.
15.
FoulisA. K. (1980) Histological evidence of initiating factors in acute necrotising pancreatitis in man. J. Clin. Pathol.38, 1125–31.
16.
FoulisA. K. (1982) Morphological study of the relation between accidental hypothermia and acute pancreatitis. J. Clin. Pathol.11, 1244–8.
17.
GoodheadB. (1969) Vascular factors in the pathogenesis of acute haemorrhagic pancreatitis. Ann. R. Coll. Surg. Eng.45, 80–97.
GoodlinR. C. (1987) The effects of severe preeclampsia on the pancreas: changes in the serum cationic trypsinogen and pancreatic amylase. Br. J. Obstet, and Gynecol.94, 1228.
20.
GrahamD. F. (1977) Incidence and mortality of acute pancreatitis. Brit. Med. J.2, 1603.
21.
HalstedW. C. (1901) Retrojection of bile into the pancreas, a cause of acute haemorrhagic pancreatitis. Bull. Johns Hopkins Hospital.12, 179–81.
22.
HanssonK.LundhG.StenrainV. (1967) The toxic effect of bile salts on the pancreas. Acta. Chir. Scand.375, 48–64.
23.
HessW. (1965) Surgery of the Biliary Passages and the Pancreas. Princeton, Van Nostrand, p. 340.
24.
HulmanG. (1986) Crohn's disease, intravenous fat emulsion and acute pancreatitis — a hypothesis. Gastroenterology91, 1584–5.
25.
ImrieC. W. (1977) Incidence and mortality of acute pancreatitis. Brit. Med. J.2, 1350.
26.
KaplanM. H. (1985) Stress, pancreatic perfusion and acute pancreatitis. A unified concept of pathogenesis. Mt. Sinai Med. (NY)52, 326–30.
27.
KelfyT. R. (1980) Gallstone pancreatitis: the timing of surgery. Surgery88, 345–50.
28.
KellyT. R. (1984) Gallstone pancreatitis. Local predisposing factors. Ann. Surg.4, 479–85.
29.
LegerL.ChicheB.LouvelA. (1981) Pancreatic necrosis and acute pancreatitis. World J. Surg.5, 315–17.
30.
MillerR. E.BaerJ. W.NizinJ. S.PascalR. R. (1985) Haemorrhagic pancreatitis: a complication of transcatheter embolization treated successfully by total pancreatectomy. Am. J. Surg.149, 802–8.
31.
MoldveenG. M.MerriamJ. C. (1967) Cholesterol embolization. From pathological curiosity to clinical entity. Circulation35, 946–53.
32.
McMahonM. J. (1977) Incidence and mortality rate of acute pancreatitis. Brit. Med. J.2, 1350.
33.
NevalainenT. J.SeppaA. (1975) Acute pancreatitis caused by closed duodenal loop in the rat. Scand. J. Gastroenterol.10, 521–6.
34.
NordbackI.LauslahtiK. (1986) Clinical pathology of acute necrotizing pancreatitis. J. Clin. Pathol.39, 68–71.
35.
NuutinenP.KivisaariL.Standertskjold-NordenstamC. G.LempinenM.SchroderT. (1986) Microangiography of the pancreas in experimental oedemic and haemorrhagic pancreatitis. Scand. J. Gastroenterol. (Suppl).126, 12–17.
36.
OpieE. L. (1901) Etiology of acute pancreatitis. Bull. Johns Hopkins Hospital.12, 182–5.
37.
PfefferR. B.Lazzarini-RobertsonA.SafadiD.MixterG.SecoyC. F.HintenJ. W. (1962) Gradations of pancreatitis, edematous through hemorrhagic experimentally produced by controlled injection of microspheres into blood vessels in dogs. Surgery51, 764–9.
38.
ProbsteinJ. G.JosheR. A.BlumenthalH. T. (1957) Atheromatous embolization. An aetiology of acute pancreatitis. Arch. Surg.75, 566–72.
39.
SchneidermanH. (1984) A neglected aetiology: atheromatous embolism. Mt. Sinai J. Med.53, 578.
40.
StolerJ.BillerJ. A.GrandR. J. (1987) Pancreatitis in Kawasaki disease. Ant. J. Dis. Child.141, 306–308.
41.
StudleyJ. G. N.SchenkW. G. (1982) Pathophysiology of acute pancreatitis. Evaluation of the effect and mode of action of steroids in experimental pancreatitis in dogs. Am. J. Surg.143, 761–4.
42.
TaylorT. V.RimmerS. (1980) Pancreatic duct reflux in patients with gallstone pancreatitis. Lancet2, 848–50.
43.
ThalA. P.PerryJ. F.EgnerW. (1957) A clinical and morphologic study of 42 cases of fatal acute pancreatitis. Surg. Gynaecol. Obstet.105, 191–2.
44.
TrapnellJ. E.DuncanE. H. L. (1975) Patterns of incidence in acute pancreatitis. Brit. Med. J.2, 179–83.
45.
WarshawA. L.O'HaraP. J. (1978) Susceptibility of the pancreas to ischaemic injury in shock. Am. Surg.188, 197–201.
46.
WellsA. D.SchenkW. G. (1982) Beneficial effect of Ethamsylate on the relative blood flow of the pancreas in acute canine necrotising pancreatitis. Surg. Gynecol. Obstet.155, 673–8.
47.
WellsA. D.ImahoriS. C.SchenkW. G. (1983) Does edematous pancreatitis exist in biliary related pancreatitis? A hemodynamic and histologic study of the progression of bile-induced pancreatitis. Arch. Surg.118, 1277–82.
48.
WilsonC.ImrieC. W. (1988) Deaths from acute pancreatitis: Why do we miss the diagnosis so frequently?Int. J. Pancreatol.3, 273–82.
