Fatal acute pancreatitis.

Abstract

SUMMARY Review of all deaths from acute pancreatitis recorded at Glasgow Royal Infirmary between 1974 and 1984 identified 126 patients, 53 (42%) of whom had pancreatitis first diagnosed at necropsy. Aetiologies of the fatal attacks of pancreatitis included gall stones (30%), alcohol (15%), other identified aetiogical factors (17%), and was unknown (38%). Overall mortality fell from 14 9% in the early half of the study to 10 8% in the latter half although in the 73 patients in whom the diagnosis of acute pancreatitis was made during life, the mortality rate was unchanged throughout. Within the group of 73 patients diagnosed during life deaths from gall stone pancreatitis have fallen by almost 50% suggesting that improved treatment of this subgroup may have occurred. The findings of this study lend support to the concept of early, complete clearance of calculi from the biliary tree, either by an endoscopic or surgical approach.In a mainly retrospective review of acute pancreatitis from Glasgow Royal Infirmary over the decade to 1970, Imrie reported an overall mortality rate of 214% . 'A recent review from Bristol of the decade to 1979 found a mortality rate of 19 6%,2 a figure little changed from that of the preceding two decades.' In prospective therapeutic trials in Glasgow, mortality from acute pancreatitis fell from 11 5% in 1971-24 to 8-7% in 1974-7.' Such prospective trials, however, give an incomplete picture of the true incidence and mortality of acute pancreatitis by excluding patients who present atypically and those not diagnosed in life. The past decade has seen many changes in the management of acute pancreatitis and its complications but it is unclear whether these have influenced overall mortality. We have therefore undertaken a review of all deaths from acute pancreatitis at Glasgow Royal Infirmary between 1974 and 1984, during which time a series of prospective therapeutic trials were being conducted.

Relaxin prevents the development of severe acute pancreatitis

“…Inflammatory mediators induce complications that can range from local to systemic evolving to a severe form with high morbi-mortality [2] . The peri-vaterian duodenum (PV-D) has an extremely rich autonomic duodenum-pancreatic inner vation therefore endoscopic maneuvers, gallstones, biliary sludge and/or hemobilia migrating and impacting on the perivaterian duodenum stimulate primary sensory neurons to unchain autonomous-arc-reflexes (AARs) responsible for the initial acute pancreatic neurogenic inflammation that may range from local and edematous to regional and necrotizing pancreatitis [3][4][5][6] .…”

Estudo Transversal dos Casos de Pancreatite Aguda Necropsiados no Instituto Médico Legal de Belo Horizonte, 2006–201

“…Dados da literatura mostram que o diagnóstico de morte por pancreatite necrotizante é feito somente por ocasião da necropsia em 30 a 50% dos casos [18][19][20][21][22] , o que coloca esta situação clínica como potencialmente associada a mortes súbitas e inesperadas, que compõem importante grupo de casos investigados pela Medicina Legal uma vez que podem ser classificadas como mortes suspeitas, em especial em locais onde não há o serviço de verificação de óbitos 23 .…”

Acute Severe Necrotising Pancreatitis Is Really a Surgical Challenge: An Overview

“…These measures can reduce the proportion of early deaths relating to circulatory, respiratory and renal failure. 30,31 These patients should be managed in an intensive therapy unit (ITU) or high dependency unit (HDU). Such patients require as a minimum peripheral venous access, a central venous line (for fluid administration and CVP monitoring), a urinary catheter and nasogastric tube.…”