ISCHEMIC ACUTE PANCREATITIS

Abstract

Background: Acute pancreatitis (AP) can be caused by various triggers. Besides alcohol excess and gallstones, pancreatic ischemia can cause AP. Although this is poorly defined clinically or radiologically as an independent entity, it should be considered when anamnestic risk factors are present and no other obvious reasons can be defined. Aim of this study was to define ischemic AP in terms of pathophysiological, radiological and clinical conditions regarding the history of 7 consecutive patients. Methods: Seven patients suffered from acute pancreatitis caused by mesenteric hypoperfusion of different origin. Course, severity and outcome of the disease as well as diagnostic and therapeutic measures were evaluated with a special focus on the differentiation between acute pancreatitis and elevated pancreatic enzyme levels, which can often be observed in ICU patients without further clinical complications. Results: Three causes of acute ischemia-induced pancreatitis were observed: hemorrhage or hypotension (3 patients), mesenteric macrovessel occlusion (3 patients) and posttransplantation pancreatitis (1 patient). Therapy of the patients was conservative in 2 patients, operative with surgical hemostasis and drainage (4 patients) and explantation of a transplanted pancreas (1 patient), respectively. Four of the patients died within 18 days after the onset of AP, indicating a severe course of AP with major systemic complications; 2 patients recovered completely, the transplant patient lost the pancreas graft after 5 days without further complications. Conclusions: Ischemia is an important etiology of acute pancreatitis. Different causes of ischemia can lead to a hypoperfusion of the pancreas with a consecutive induction of an inflammatory response. Diagnostic and therapeutic procedures are similar to those performed in acute pancreatitis of other etiology, causal therapy includes restoration of pancreatic perfusion, if possible. Severity of the disease can range from moderate edematous affections up to severe courses with lethal outcome. However, in the reported patients mortality was high, indicating that ischemia of the pancreas, when present at the onset of the disease, tends to lead to a severe, often irreversible organ damage with early and fatal systemic complications.