Comparative radiological and morphological study of the human pancreas. IV. Acute necrotizing pancreatitis in man.

In 40 patients with massive acute pancreatitis the pancreata (autoptical 30, surgical 6, surgical + autoptical 4) were studies by ductography and extensive histology. The study shows that in man acute pancreatitis starts with fat necrosis around and within the pancreas. In second step acinar cell necorsis as well as vascular destruction and thrombosis arise in the immediate neighbourhood of the fat necorsis. In about 25% the vascular lesions are followed by infarction-like necrosis of the pancreas. The study strongly suggests that the pancreatic lipase is the key-enzyme in the development acute pancreatitis by releasing membrane-toxical fatty acids.