Summary
Histological examination of the pancreas disclosed acute diffuse interstitial pancreatitis in nine cases (0.62%) out of 1457 autopsies performed in 3 yr at two general hospitals in Tokyo. In this series, there were 11 cases of necrotizing or hemorrhagic pancreatitis. In addition to diffuse phlegmonous inflammation, acute interstitial pancreatitis was characterized by rupture of the ducts and ductules associated with profuse intraluminal exudation of polymorphonuclear leukocytes and protein plugs formation. There was scarce parenchymal or fat necrosis. The interstitial type may represent characteristics of acute pancreatitis in the aged. In all nine cases, there were few clinical signs suggestive of acute pancreatitis, except for shock, that developed rapidly. Duration of the disease was rather short. Diagnosis of acute pancreatitis was not made before death. In five patients, acute pancreatitis was terminally superimposed on other serious ailments. But in the other four cases, acute pancreatitis was disclosed as the primary disease at autopsy. Although there was only one case that had a possibility of being secondary to biliary tract infection, ascending bacterial infection and impaired secretion by atrophic parenchyma seemed to be involved in its pathogenesis.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Gyr KE, Singer MV, and Sarles H. Revised classification of pancreatitis—Marseille 1984. Gyr KE, Singer MV, and Sarles H, Eds. Pancreatitis, concepts and classification. Excerpta Medica, Amsterdam and New York. International Congress Series 642, 1984: pp. xxiii–xxv.
Gray SH, Probstein JG, and Heifets CJ. Transient acute pancreatitis. Ann Surg 1938; 108: 1029–1051.
Siler VE, Wulsin JH, and Chater BN. II. Important clinical factors of acute pancreatitis. Surg Gynecol Obstet 1955; 100: 357–365.
Love RJM. Acute pancreatitis; clinical features and treatment. Lancet 1926; 2: 1262–1264.
Schmieden V. and Sebening W. Surgery of pancreas, with special consideration of acute pancreatic necrosis. Surg Gynecol Obstet 1928; 46: 735–751.
Stetten D. Subacute pancreatitis or so-called acute oedema of pancreas. Ann Surg 1930; 92: 248–262.
Zoepffel H. Das akute Pankreasoedem, eine Vorstufe der akuten Pancreasnekros. Deut Zschr Chir (Leipzig) 1922; 175: 301–312.
AmmannR and Warshaw AL. Acute pancreatitis: clinical aspects and medical and surgical management. Haubrich WS, Kaiser MH, Roth JLA, and Schaffner F, eds. Bokus Gastroenterology, William B. Saunders Philadelphia and London, 1985: pp. 3993–4019.
Kloeppel G, Gerkan R, Dreyer T. Pathology of acute pancreatitis. Analysis of 367 autopsy cases and 3 surgical specimens. Gyr KE, Singer MV, and Sarles H. eds. Pancreatitis— concepts and classification, Excerpta Medica, Amsterdam, and New York, International Congress Series642, 1984; pp. 29–35.
Quick, B. Acute pancreatitis. Aust NZ J Surg 1932; 2: 115–140.
Elman R. Acute interstitial pancreatitis; clinical study of thirty seven cases showing oedema, swelling, and induration of pancreas but without necrosis, hemorrhage, or suppuration. Surg Gynecol Obstet 1933; 57: 291–309.
Popper HL, Necheles H, and Russell KC. Transition of pancreatic edema into pancreatic necrosis. Surg Gynecol Obstet 1948; 87: 79–82.
Thal AP, Perry JF, Jr, and Egner W. A clinical and morphologic study of forty two cases of fatal acute pancreatitis. Surg Gynecol Obstet 1957; 105: 191–202.
Evans HW, Gross JB, and Baggenstoss AH. Acute and subactue interstitial pancreatitis: A clinicopathologic study. Gastroenterology 1958; 35: 457–464.
Hayashi K. Pathology of pancreatic diseases—with special reference to acute pancreatitis. Stomach and Intestine 1974; 9: 1407–1420.
Matsuda T. Disseminated intravascular coagulopathy (DIC). Clin Hemat 1976; 17: 1139- 1152.
Stein AA and Powers SR Jr., Terminal pancreatitis. Arch Pathol 1958; 65: 445–448.
Sacher LA and Probstein JG. Terminal acute pancreatitis. Am J Digest Dis 1954; 21: 52.
Czernobilsky B and Mikat KW. The diagnostic significance of interstitial pancreatitis found in autopsy. Am J Clin Pathol 1964; 41: 33–43.
Kerschner F. Quoted by Elman R in Surg Gynecol Obstet 1933; 57: 291–309.
Opie EL. The etiology of acute hemorrhagic pancreatitis. Am J Med Sci 1901; 121: 182- 188.
Opie EL. The relation of cholelithiasis to disease of the pancreas and to fat necrosis. Am J Med Sci 1901; 121: 27–43.
Howard JM, and Jordan GL. Surgical disease of the pancreas. J. B. Lippincott, Philadelphia, 1960: pp. 169–189.
Gambil EE. Etiology and mechanisms of pancreatitis. Gambil EE, ed. Pancreatitis. CV Mosby, 1973: pp. 50–82.
Archibald E. Acute edema of the pancreas. A clinical and experimental study. Ann Surg 1929; 90: 803–816.
Kimura W, Ohtsubo K, Shimada H, Kuroda A, and Morioka Y. Background of the carcinoma of gallbladder and extrahepatic bile ducts. Jpn J. Geriat 1987; 24: 432–436.
Baggenstoss AH. Pathology of pancreatitis. Gambil EE, ed. Pancreatitis. CV Mosby, 1973: 179–212.
Howard A Reber MD. Acute pancreatitis: The role of duct permeability. Gyr KE, Singer MV, and Sarles H, eds. Pancreatitis, concepts, and classification, Excerpta Medica, Amsterdam and New York, International Congress Series642, 1984: pp. 149–151.
Filky ME. Exocrine pancreatic functions in the aged. Am J Geriatr Soc 1968; 16: 463–468.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Kimura, W., Ohtsubo, K. Clinical and pathological features of acute interstitial pancreatitis in the aged. Int J Pancreatol 5, 1–10 (1989). https://doi.org/10.1007/BF02925693
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02925693