Abstract
A large retrospective autopsy study of patients was analyzed to evaluate the major etiologic and pathologic factors contributing to fatal acute pancreatitis (AP). From an autopsy population of 50,227 patients, 405 cases were identified where AP was defined as the official primary cause of death. AP was classified according to morphological and histological, but not biochemical, criteria. Patients with AP died significantly earlier than a control autopsy population of 38,259 patients. Sixty percent of the AP patients died within 7 days of admisssion. Pulmonary edema and congestion were significantly more prevalent in this group, as was the presence of hemorrhagic pancreatitis. In the remaining 40% of patients surviving longer than 7 days, infection was the major factor contributing to death. Major etiologic groups in AP were chronic alcoholism; postabdominal surgery; common duct stones; a small miscellaneous group including viral hepatitis, drug, and postpartum cases; and a large idiopathic group comprising patients with cholelithiasis, diabetes mellitus, and ischemia. The prevalence of established diabetes mellitus in the AP group was significantly higher than that observed in the autopsy control series, suggesting that this disease should be considered as an additional risk factor influencing survival in AP. Pulmonary complications, including pulmonary edema and congestion, appeared to be the most significant factor contributing to death and occurred even in those cases where the pancreatic damage appeared to be only moderate in extent. Emphasis placed on the early recognition and treatment of pulmonary edema in all cases of moderate and severe AP should contribute significantly to an increase in survival in this disease.
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Imrie CW, Whyte AS: A prospective study of acute pancreatitis. Br J Surg 62:490–494, 1975
Jacobs ML, Daggett WM, Civetta JM, Vasu A, Lawson DW, Warshaw AL, Nardi GL, Bartlett MK: Acute pancreatitis: Analysis of factors influencing survival. Ann Surg 185:43–51, 1977
Kessler E, Mieny CJ: Biliary pancreatitis. S Afr Med J 49:2046–2048, 1975
Olsen H: Pancreatitis: A prospective clinical evaluation of 100 cases and review of the literature. Am J Dig Dis 19:1077–1090, 1974
Ranson JHC, Rifkind KM, Turner JW: Prognostic signs and nonoperative peritoneal lavage in acute pancreatitis. Surg Gynecol Obstet 143:209–219, 1976
Switz DM: Acute alcoholic pancreatitis: Effect of clinical presentation and therapies on outcome at a VA hospital. Ann Intern Med 78:816–817, 1973
Trapnell JE: The natural history and prognosis of acute pancreatitis. Ann R Coll Surg Engl 38:265–287, 1966
White TT, Heimback DM: Sequestrectomy and hyperalimentation in the treatment of hemorrhagic pancreatitis. Am J Surg 132:270–275, 1976
Geokas MC, Rinderknecht H, Walberg CB, Weissman R: Methemalbumin in the diagnosis of acute hemorrhagic pancreatitis. Ann Intern Med 81:483–486, 1974
Enquist IF, Gliedmand ML: Gross autopsy findings in cases of fatal acute pancreatitis. Arch Surg 77:985–991, 1958
Fishbein R, Murphy GP, Wilder RJ: The pleuropulmonary manifestations of pancreatitis. Dis Chest 41:392–397, 1962
Kaye MD: Pleuropulmonary complications of pancreatitis. Thorax 23:297–306, 1968
Roseman DW, Kowlessar OD, Sleisenger MH: Pulmonary manifestations of pancreatitis. N Engl J Med 263:294–296, 1960
Stein GN, Kalser MH, Sarian NN, Finkelstein A: An evaluation of the roentgen changes in acute pancreatitis: Correlation with clinical findings. Gastroenterology 36:354–361, 1959
Ranson JHC, Roses DF, Fink SD: Early respiratory insufficiency in acute pancreatitis. Ann Surg 178:75–79, 1973
Ranson JHC, Turner JW, Roses DF, Rifkind KM, Spencer FC: Respiratory complications in acute pancreatitis. Ann Surg 179:557–564, 1974
Warshaw AL, O'Hara PJ: Susceptibility of the pancreas to ischemic injury in shock. Ann Surg 188(2):197–201, 1978
Lukash WM: Complications of acute pancreatitis. Am J Gastroenterol 49:120–125, 1968
Storck G, Pettersson G, Edlund Y: A study of autopsies upon 116 patients with acute pancreatitis. Surg Gynecol Obstet 143:241–245, 1976
Lankisch PG, Rahlf G, Koop H: Pulmonary complications in fatal acute hemorrhagic pancreatitis. Dig Dis Sci 28(2): 111–116, 1983
Snedecor GW, Cochran WG: Statistical Methods, 6th ed. Ames, Iowa, The Iowa State University Press, 1967
Karger L, Lindberg S, Agren G: Alcohol consumption and acute pancreatitis in men. Scand J Gastroenterol 7(Suppl 15):2–38, 1972
Opie EL: The etiology of acute hemorrhagic pancreatitis. Johns Hopkins Hosp Bull 12(121):182–188, 1901
Cameron JL, Zuidema GD, Margolis S: A pathogenesis for alcoholic pancreatitis. Surgery 77:754–763, 1975
Albo R, Silen W, Goldman L: A critical clinical analysis of acute pancreatitis. Arch Surg 86:1032–1038, 1963
Brooks FP: Diseases of the Exocrine Pancreas. Philadelphia: WB Saunders, 1980, p 8.
James O, Agnew JE, Bouchier IAD: Chronic pancreatitis in England: A changing picture? Br Med J 2:34–38, 1974
Acosta JM, Ledesma CL: Gallstone migration as a cause of acute pancreatitis. N Engl J Med 290:484–487, 1974
Acosta JM, Rossi R, Ledesma CL: The usefulness of stool screening for diagnosing cholelithiasis in acute pancreatitis. Am J Dig Dis 22:168–172, 1977
Opie EL: The relation of cholelithiasis to disease of the pancreas and to fat necrosis. Am J Med Sci 121:27–43, 1901
Banks PA: Pancreatitis. New York, Plenum Medical Book Co, 1979, p 14
White TT: Results of 89 operations for pancreatitis: A personal experience. Surgery 58:1061–1074, 1965
Bardenheier JA III, Kaminski DL, Willman VL: Pancreatitis after biliary tract surgery. Am J Surg 116:773–776, 1968
Koch H, Rosch W, Schaffner O, Demling L: Endoscopic papillotomy. Gastroenterology 73:1393–1396, 1977
Ponka JL, Landrum SE, Chaikof L: Acute pancreatitis in the postoperative patient. Arch Surg 83:475–490, 1961
Dressel TD, Goodale RL, Arneson MA, Borner JW: Pancreatitis as a complication of anticholinesterase insecticide intoxication. Ann Surg 189(2):199–204, 1979
Lampel M, Kern HF: Acute interstitial pancreatitis in the rat induced by excessive doses of a pancreatic secretagogue. Virchows Arch A Pathol Anat Histol 373:97–117, 1977
Adler G, Hupp T, Kern HF: Course and spontaneous regression of acute pancreatitis in the rat. Virchows Arch A Pathol Anat Histol 382:31–47, 1979
Renner IG, Wisner JR, Rinderknecht H: The protective effects of exogenous secretin on ceruletide induced acute pancreatitis in the rat. J Clin Invest 72:1081–1092, 1983
Renner IG, Wisner JR, Rinderknecht H: Lung pathology in hamsters with experimentally induced acute pancreatitis. Clin Res 31(1):33A, 1983
Renner IG, Pantoja JL, Abramson SB, Douglas AP, Russell FE, Koch MK: Effects of scorpion and rattlesnake venoms on the canine pancreas following pancreaticoduodenal arterial injections. Toxicon 21(3):405–420, 1983
Pantoja JL, Renner IG, Abramson SB, Edmondson HA: Production of acute hemorrhagic pancreatitis in the dog using venom of the scorpion Buthus quinquestriatus. Dig Dis Sci 28(5):429–439, 1983
Probstein JG, Joshi RA, Blumenthal HT: Atheromatous embolization. Arch Surg 75:566–572, 1957
Moberg A, Svenhamn K, Wagermark J: Acute “idiopathic” pancreatitis. Acta Chir Scand 134:369–372, 1968
Pellegrini CA, Paloyan D, Acosta JM, Skinner DB: Acute pancreatitis of rare causation. Surg Gynecol Obstet 144:899–902, 1977
Tully GT, Lowenthal JJ: The diabetic coma of acute pancreatitis. Ann Intern Med 48:310–319, 1958
Blumenthal HT, Probstein JG, Berns AW: Interrelationship of diabetes mellitus and pancreatitis. Arch Surg 87:156–162, 1963
Malone JI: Juvenile diabetes and acute pancreatitis. J Pediatr 85(6):825–827, 1974
Goodhead B: Vascular factors in the pathogenesis of acute hemorrhagic pancreatitis. Ann R Coll Surg Engl 45:80–97, 1969
O'Sullivan JN, Norbrega FT, Morlock CG, Brown AL, Bartholomew LG: Acute and chronic pancreatitis in Rochester, Minnesota, 1940 to 1969. Gastroenterology 62:373–379, 1972
Lazarus SS, Volk BW: Pancreas in maturity-onset diabetes, pathogenetic considerations. Arch Pathol 71:44–59, 1961
Finley JW: Respiratory complications of acute pancreatitis. Am Surg 35:591–598, 1969
Warshaw AL, Lesser PB, Rie M, Cullen DJ: The pathogenesis of pulmonary edema in acute pancreatitis. Ann Surg 182(4):505–510, 1975
Hayes MF, Rosenbaum RW, Zibelman M, Matsumoto T: Adult respiratory distress syndrome in association with acute pancreatitis. Am J Surg 127:314–319, 1974
Kellum JM, DeMeeter TR, Elkins RC, Zuidema GD: Respiratory insufficiency secondary to acute pancreatitis. Ann Surg 175:657–662, 1972
De Troyer A, Naeije R, Yernault J, Englert M: Impairment of pulmonary function in acute pancreatitis. Chest 73(3): 360–363, 1978
Toffler AH, Spiro HM: Shock or coma as the predominant manifestation of painless acute pancreatitis. Ann Intern Med 57:655–659, 1962
Feller JH, Brown RA, Toussaint GPM, Thompson AG: Changing methods in the treatment of severe pancreatitis. Am J Surg 127:196–201, 1974
Stone HH, Fabian TC: Peritoneal dialysis in the treatment of acute alcoholic pancreatitis. Surg Gynecol Obstet 150:878–882, 1980
Banks PA: Pancreatitis. New York, Plenum Medical Book Co, 1979, p 113
Howes R, Zuidema GD, Cameron JL: Evaluation of prophylactic antibiotics in acute pancreatitis. J Surg Res 18:197–200, 1975
Louw JH, Marks IN, Bank S: The management of severe acute pancreatitis. Postgrad Med J 43:31–44, 1967
Finch WT, Sawyers JL, Schenker S: A prospective study to determine the efficacy of antibiotics in acute pancreatitis. Ann Surg 183:667–671, 1976
Sarles H: Chronic calcifying pancreatitis—chronic alcoholic pancreatitis. Gastroenterology 66:604–616, 1974
Strum WB, Spiro HM: Chronic pancreatitis. Ann Intern Med 74:264–277, 1971
Sarles H, Tiscornia O: Ethanol and chronic calcifying pancreatitis. Med Clin North Am 58:1333–1346, 1974
Renner IG, Savage WT III, Stace NH, Pantoja JL, Schultheis WM, Peters RL: Frequency of pancreatitis in alcoholic liver disease. Dig Dis Sci 29(7):593–599, 1984
Renner IG, Rinderknecht H, Valenzuela JE, Douglas AP: Studies of pure pancreatic secretions in chronic alcoholic subjects without pancreatic insufficiency. Scand J Gastroenterol 15:241–244, 1980
Renner IG, Rinderknecht H, Stace NH: Pure pancreatic secretions in male and female chronic alcoholic patients without pancreatic insufficiency. Gastroenterology 80(5):1261, 1981
Blenkinsopp WK: The liver and pancreas in acute necrotizing pancreatitis. J Clin Pathol 31:791–793, 1978
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Renner, I.G., Savage, W.T., Pantoja, J.L. et al. Death due to acute pancreatitis. Digest Dis Sci 30, 1005–1018 (1985). https://doi.org/10.1007/BF01308298
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DOI: https://doi.org/10.1007/BF01308298