Verfärbungen der Bauchdecke bei Pankreatitis

Schädler, Julia; Birngruber, Christoph G.; Püschel, Klaus; Schröder, A; Sperhake, Jan‐Peter

doi:10.1007/s00194-018-0239-5

Cited by 3 publications

(1 citation statement)

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“…Overall, the differential diagnostics of skin discolorations should include the distinction from hematoma or ecchymosis due to blunt force or needle puncture sites because this could feign the origin of skin signs associated with pancreatitis [ 20 ]. In both cases, there was no clear evidence of blunt force or needle punctures although small injections are not always visible and therefore cannot be ruled out with absolute certainty.…”

Section: Discussionmentioning

confidence: 99%

Fox sign in a case of terminal stage pancreatic cancer and suggestions for diagnosis

Prangenberg

Doberentz

Madea

2021

Forensic Sci Med Pathol

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Skin signs in acute pancreatitis are well-known and frequently discussed manifestations accompanied by unfavorable prognoses although they may rarely appear in clinical and forensic medicine. In 2018, the district attorney’s office ordered a forensic autopsy for a 74-year-old man with terminal stage pancreatic cancer. The autopsy was ordered based on accusations of the deceased’s widow regarding alleged medical malpractice and poor hospital care. The widow filed a grievance about multiple unsuccessful attempts to draw blood from her husband in addition to a diaper dermatitis at the right groin. An autopsy and additional histological examinations were performed. After considering all findings, the diaper dermatitis was eventually assumed to be a Fox sign caused by acute pancreatitis, and the allegations of medical malpractice were refuted. This case led us to identify another case with suspected cutaneous manifestations in pancreatic disease. We performed immunohistochemical staining on those two cases and six control cases to examine whether there was detectable presence of pancreatic lipase and trypsin in the skin discolorations and whether it could be used as a feasible method to verify skin signs associated with pancreatitis. Based on our findings, a minor disseminated lipase and trypsin staining should be considered regular and is therefore not conclusive of a skin sign associated with pancreatitis. Moreover, trypsin does not seem to be as suitable as lipase for this suggested immunohistochemical method. Nevertheless, this method might be a useful addition for determining the origin of skin discoloration and verifying skin signs associated with pancreatitis.

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Section: Discussionmentioning

confidence: 99%