Year 2017 Vol. 25 No 3




EE "Belarusian State Medical University" 1 Minsk,
EE "Vitebsk State Medical University" 2, Vitebsk
ME "City Clinical Pathoanatomical Bureau"3 , Minsk,
Medical service of the 120th separate mechanized brigade of the Armed Forces of the Republic of Belarus 4,Minsk
The Republic of Belarus

Objectives. To study thanatogenetic aspects of morphological disorders causing the development of lethal outcomes in acute destructive pancreatitis in phases of fusion, sequestration and pyo-septic complications.
Methods. A retrospective analysis of 89 reports of persons died of acute destructive pancreatitis being treated in the healthcare establishments of Minsk (2005-2015) was performed. The examination of 214 histological preparations of the internal organs, stained with hematoxylin-eosin, was carried out.
Results. Subtotal and total affection of the pancreas was established in more than 88% of autopsies, the postoperative peritonitis in 43,8%, different kinds of purulent parapancreatitis in 55,1%, generalized phlegmon of the retroperitoneal cellular tissue in 85,7% of cases. Leading thanatogenetic disorders in persons died of acute destructive pancreatitis were caused by the hepatoprime syndrome, respiratory distress-syndrome, renal and cardiac failure, established in 52,8%, 49,4%, 35,9% and 32,6% of cases, which was confirmed by the relevant morphological changes. The basis of morphological disorders of the internal organs of persons, died from acute destructive pancreatitis are the following: in the liver edema of the intermediate spaces of hepatocytes (76,6%); lymphoid neutrophilic infiltration of the portal tracts (65,9%) and centrilobular hepatocyte necrosis (75,7%); in the lungs interstitial edema (75,0%), microvascular thrombosis, desquamation of respiratory epithelium (88,6%); in the kidney renal tubular epithelial dystrophy (90,6%) accompaying by the development of epithelium necrosis of the convoluted tubules (necrotic nephrosis) (56,3%). At 42 persons, died of the acute destructive pancreatitis, against pyo-septic complications, the signs of septic spleen with atrophy of follicles and pulp emptying were revealed, that testify the presence of severe secondary immunodeficiency involving the cellular and humoral components.
Conclusion. The established disorders determine the necessity of improving the diagnostic criteria of acute destructive pancreatitis, carrying out the differentiated surgical approach for performance of programmable necrosequestrectomy in generalized forms and puncture-aspiration interventions in the located restricted cystic-fluid collections, elimination of the main pathogenetic disorders - intoxication, hypoxia and secondary immunodeficiency.

Keywords: acute destructive pancreatitis, morphological disorders of the internal organs, thanatogenetic aspects of multiple organ, failure development, pancreonecrosis, phlegmon of retroperitoneal fat, intoxication, hypoxia
p. 250-256 of the original issue
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Address for correspondence:
220116, Republic of Belarus, Minsk,
Dzerzhinsky Ave., 83
Belarusian State Medical University,
Department of general surgery,
Tel.: 8 017 226-17-02,
Sergey A. Alekseev
Information about the authors:
Alekseev S.A. MD, Professor, Head of department of general surgery, EE "Belarusian State Medical University".
Usovich A.K. MD, Professor, Head of department of human anatomy, EE "Vitebsk State Medical University".
Koshevski P.P. PhD, Ass. Professor of department of general surgery, EE "Belarusian State Medical University".
DudkoA.A. Post-graduate student of department of general surgery, EE "Belarusian State Medical University", Head of department of surgery, ME "The 3rd City Clinical Hospital named after E.V.Klumov".
Tarasenko A.V. PhD, Lieutenant Colonel of Medical Service, the deputy chief medical officer of the 120th separate mechanized brigade of the Armed Forces of the Republic of Belarus.
Shestopalov S.A. Head of autopsy department, ME "City Clinical Pathoanatomical Bureau", Minsk.
Alekseev V.S. Medical student of EE "Vitebsk State Medical University".
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