Determination of necrosis in necrotizing pancreatitis

Abstract

The diagnosis of necrosis and its extent in acute necrotizing pancreatitis is one main problem in establishing criteria for possible pancreatectomy. With this in mind a clinicopathological analysis was carried out on 54 patients who had undergone pancreatic resection for acute necrotizing pancreatitis. The macroscopic appearance of the gland correlated poorly with its histology. Parenchymal necrosis varied from 0 to 100 per cent of the resected specimen though all the glands were considered totally or subtotally necrotic. In the clinicobiochemical status no criteria were found determining the extent of necrosis. Obesity, hypotension, hypocalcaemia and elevated serum creatinine in severely ill patients (as determined by Ranson criteria) strongly supported extensive peripancreatic and septal necrosis; however, 38 per cent of patients developed necrosis without those stigmata. While waiting for new methods to determine necrosis we prefer conservative treatment. In contrast to our previous tactics we think that resection should be limited to extreme cases in order to avoid resection of glands with limited necrosis and thus mainly reversible parenchymal damage.

Treatment of Acute Pancreatitis: An Attempted Historical Review

“…Nordmann [4] gained the impression that a surgical procedure accelerated the development of necrotizing pancreatitis; this too was perhaps a consequence of the lack of intensive therapy. Nordback et al [12] later confirmed what many surgeons reported, namely that the macroscopic appearance of the gland correlated poorly with its histology. Parenchymal necrosis varied from 0 to 100% of the resected specimen, although at operation all the glands were considered totally or subtotally necrotic.…”

Is obesity a risk factor in acute pancreatitis? A meta-analysis

“…Obese patients probably have an increased accumulation of peripancreatic fat. Nordback et al [28] showed that in cases of necrotizing acute pancreatitis the amount of septal and peripancreatic necrosis was greatest in obese patients. Also, it is known that the risk of infection of the pancreas is proportional to the amount of pancreatic necrosis [29].…”

Overweight Is an Additional Prognostic Factor in Acute Pancreatitis: A Meta-Analysis

“…As adipose tissue has been considered as an important source of cytokines, one explanation is that a large amount of adipose tissue is often correlated with a low-level chronic inflammatory state which may facilitate the inflammatory process of AP [9,14]. Another explanation is that necrosis of peripancreatic tissue, which is mainly composed of adipose tissue, may release large amounts of inflammatory cytokines and worsen the prognosis of AP [4,15]. …”