Year 2015 Vol. 23 No 4




EE "Gomel State Medical University" 1,
E "Gomel Regional Clinical Pathoanatomical Bureau" 2,
The Republic of Belarus

Objectives. The study of regularities of spreading of the pathological process in the retroperitoneal area in severe destructive pancreatitis.
Methods. The ongoing retrospective analysis according to the report of 180 autopsy cases revealing the acute destructive pancreatitis (the data of Gomel regional clinical pathoanatomical bureau (1990-2014) was carried out during the research.
Results. The performed analysis of morphological changes of internal organs showed that the cause of early lethal outcomes is a massive enzymatic uncorrected intoxication. Fulminant necrotizing pancreatitis was registered in 70 cases, composing 38,9% of all observations. The first five days these patients have been subjected to intensive therapy due to incurable pancreatogenic shock in the intensive care unit. Particular attention was paid to the peculiarities of the anatomical relationship between destructive changes of the pancreas and affected peripancreatic cellular tissue. The obligate lesion of the peripancreatic cellular tissue in the presence of necrotic foci in the pancreatic parenchyma was established.
The actual total number of cases of total pancreatic necrosis revealed by autopsy was appeared fewer than initially assumed according to clinical and intraoperative examinations.
In case of massive pancreatic parenchymal necrosis reaching 30-60% of the pancreatic parenchyma, the formation of large peripancreatic sequesters, encapsulated in anatomically multiple closed cavities and maintaining high level of tissue intoxication has been constantly observed. Analysis of surgical treatment results detected one of the main reasons of deaths from pancreatitis surgery was suppurative necrotic parapancreatitis.
Conclusion. Pancreatogenic shock with its complications was detected as a main cause of death. Morphological manifestations of pancreatogenic shock were: enzymatic serosanguineous peritonitis and generalized parapancreatitis, massive atelectasis and pulmonary edema with hemorrhages, edema, and swelling of the brain as well as the marked dystrophic changes of parenchymal organs.

Keywords: acute necrotizing pancreatitis, parapancreatitis, total and large focal pancreatic necrosis, pancreatogenic shock, tissue intoxication, multiple organ failure, autopsy study
p. 385-390 of the original issue
  1. Miller SV, Vinnik IS, Tepliakova OV. Lechenie bol'nykh ostrym destruktivnym pankreatitom [Treatment of patients with acute destructive pancreatitis]. Khirurgiia. Zhurn im NI Pirogova. 2012;(5):24–30.
  2. Balnykov SI, Petrenko TF. Prognozirovanie iskhoda zabolevaniia u bol'nykh nekroticheskim pankreatitom [Predicting the outcome of the disease in patients with necrotizing pancreatitis]. Khirurgiia. 2010;(3):37-40.
  3. Dunaevskaia SS. Antiufrieva DA. Prognozirovanie vozmozhnosti iskhoda pri tiazhelom ostrom pankreatite [Predicting possible outcome in severe acute pancreatitis]. Vrach-Aspirant. 2013;56(11):203-207.
  4. Afanas'ev AN, Kirillin AV, Shalygin AB. Otsenka rezul'tatov khirurgicheskogo lecheniia ostrogo destruktivnogo pankreatita [Evaluation of the results of surgical treatment of acute destructive pancreatitis]. Vestn Eksperiment i Klin Khirurgii. 2010;4(3):308-16.
  5. Tolstoi A, Panov V, Krasnorogov V, Vashetko R, Skorodumov A. Parapankreatit. Etiologiia, patogenez, diagnostika, lechenie [Parapancreatitis. Etiology, pathogenesis, diagnosis, treatment]. Saint-Petersburg, RF: Iasnyi Svet, 2003. 256 p.
  6. Bradley EL 3rd, Dexter ND. Management of severe acute pancreatitis: a surgical odyssey. Ann Surg. 2010 Jan;251(1):6-17. doi: 10.1097/SLA.0b013e3181c72b79
  7. Bradley EL 3 rd. A clinically based classification system for acute pancreatitis. Summary of the international symposium on acute pancreatitis. Arch Surg. 1993 May;128(5):586-90.
  8. Doroshkevich SV, Doroshkevich EIu. Eksperimental'noe modelirovanie ostrogo pankreatita [Experimental modeling of acute pancreatitis]. Novosti Khirurgii. 2008;16(2):14-21.
  9. Zinenko DIu, Sukhina TV. Izmeneniia struktury podzheludochnoi zhelezy v usloviiakh modelirovaniia eksperimental'nogo ostrogo pankreatita [Changes in the structure of the pancreas in a simulation of experimental acute pancreatitis]. Morfologiia. 2010;4(1):17-21.
  10. Hartwig W, Schimmel E, Hackert T, Fortunato F, Bergmann F, Baczako A, Strobel O, Büchler MW, Werner J. A novel animal model of severe pancreatitis in mice and its differences to the rat. Surgery. 2008 Sep;144(3):394-403. doi: 10.1016/j.surg.2008.04.006.
  11. Ushkevich AL, Zhandarov KN, Prokopchik NI. Modelirovanie ostrogo destruktivnogo pankreatita, parapankreatita v eksperimente [Simulation of acute destructive pancreatitis, parapancreatitis in experiment]. Novosti Khirurgii. 2010;18(2):8-14
Address for correspondence:
246000, Republic of Belarus,
g. Gomel, ul. Bratev Lizyukovyih, d. 5,
UO "Gomel'skii gosudarstvennyi
meditsinskii universitet"
kafedra khirurgicheskih bolezney №2
s kursami anesteziologii i detskoy khirurgii,
tel.mob. 375 29 328 54 43,
tel.mob. 375 29 328 54 43,
Mayorov Vadim Mihaylovich
Information about the authors:
Dundarov Z.A. MD, professor, a head of the surgical diseases chair №2 with a course of anesthesiology and pediatric surgery of EE "Gomel State Medical University".
Mayorov V.M. PhD, an associate professor of the surgical diseases chair №2 with a course of anesthesiology and pediatric surgery of EE "Gomel State Medical University".
Avizhets Y.N. A head of the pathoanatomical department №1 of E "Gomel Regional Clinical Pathoanatomical Bureau".
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