STUDY OF AUTOPSIES UPON 116 PATIENTS WITH ACUTE-PANCREATITIS

Abstract

A series of 116 nonselected and consecutive patients with acute pancreatitis with a fatal outcome underwent necropsy and were analyzed with special attention paid to hepatic findings and the cause of death. This series includes the total fatalities caused by the disease during a 15 yr period from 1956 to 1970. All but 2 patients died in the 1st attack of acute pancreatitis. The patients were divided into 4 etiologic groups: gallstone disease, 43%; alcoholism, 25%; idiopathic origin, 18%, and postoperative origin, following abdominal operations, 14%. Over the 3 5-yr periods, the frequency of alcohol abuse as a predisposing factor increased, while gallstone disease showed a corresponding decrease. About 75% of the patients had hyperbilirubinemia. Half of these showed signs of cholestasis. Macroscopic steatosis of the liver was recorded in 62% of the alcohol addicts and in about 25% of the patients in the other etiologic groups. Shock and late sequelae of shock were the dominating immediate causes of death in 72%. About 50% of the fatalities occurred within the 1st wk. Most of these early deaths were caused by intractable circulatory failure. Early death was most commonly caused by alcoholism, followed in frequency by gallstone disease. Impaired hepatic function may contribute to the fatal outcome in both early and late phases of the disease.