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Fatal Acute Pancreatitis Occurring Outside of the Hospital: Clinical and Social Characteristics

World Journal of Surgery volume 34, pages 2286–2291 (2010)Cite this article

Abstract

Background

Mortality caused by acute pancreatitis in patients admitted to the hospital has been thoroughly investigated, but knowledge regarding outpatient fatalities is far from complete. The purpose of this study was to assess the incidence and clinical characteristics of patients who have died due to acute pancreatitis occurring outside the hospital.

Methods

Deaths caused by acute pancreatitis in the southern part of Sweden during 1994–2008 were identified at the Department of Forensic Medicine, Lund. A retrospective review of all cases was performed.

Results

A total of 50 patients were included, representing approximately 50 of 292 (17%) of all deaths due to acute pancreatitis in the region during this period of time. Median age was 54 (47–69) years and the majority—37 (74%)—were men. The main etiology was alcohol, seen in at least 35 (70%) patients. Twelve (24%) patients were obese. The duration of abdominal pain, in evaluable cases, was 3.0 (1.6–6.2) days. Profound signs of pancreatitis were seen in all patients; 35 (70%) had a necrotising disease according to histopathological examination. Pulmonary changes were common, e.g., bronchopneumonia, pleural effusion, or edema, and all but four had fatty liver. Massive intra-abdominal bleeding was seen in one patient. At least eight patients had a mental disorder, and three were homeless.

Conclusions

Fatal acute pancreatitis occurring outside the hospital accounts for a substantial part of all deaths due to the disease. The incidence seems to decline, and no variation in season was seen. Alcohol was the predominant etiology. Many of the patients lived alone and in poor social conditions.

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References

  1. Beger HG, Rau BM (2007) Severe acute pancreatitis: clinical course and management. World J Gastroenterol 13:5043–5051

    PubMed  Google Scholar 

  2. Blum T, Maisonneuve P, Lowenfels AB et al (2001) Fatal outcome in acute pancreatitis: its occurrence and early prediction. Pancreatology 1:237–241

    CAS  Article  PubMed  Google Scholar 

  3. Carnovale A, Rabitti PG, Manes G et al (2005) Mortality in acute pancreatitis: is it an early or a late event? JOP 6:438–444

    PubMed  Google Scholar 

  4. Gloor B, Muller CA, Worni M et al (2001) Late mortality in patients with severe acute pancreatitis. Br J Surg 88:975–979

    CAS  Article  PubMed  Google Scholar 

  5. Mofidi R, Duff MD, Wigmore SJ et al (2006) Association between early systemic inflammatory response, severity of multiorgan dysfunction and death in acute pancreatitis. Br J Surg 93:738–744

    CAS  Article  PubMed  Google Scholar 

  6. Appelros S, Borgstrom A (1999) Incidence, aetiology and mortality rate of acute pancreatitis over 10 years in a defined urban population in Sweden. Br J Surg 86:465–470

    CAS  Article  PubMed  Google Scholar 

  7. Lankisch PG, Schirren CA, Kunze E (1991) Undetected fatal acute pancreatitis: why is the disease so frequently overlooked? Am J Gastroenterol 86:322–326

    CAS  PubMed  Google Scholar 

  8. Mann DV, Hershman MJ, Hittinger R et al (1994) Multicentre audit of death from acute pancreatitis. Br J Surg 81:890–893

    CAS  Article  PubMed  Google Scholar 

  9. Wilson C, Imrie CW, Carter DC (1988) Fatal acute pancreatitis. Gut 29:782–788

    CAS  Article  PubMed  Google Scholar 

  10. Wilson C, Imrie CW (1988) Deaths from acute pancreatitis: why do we miss the diagnosis so frequently? Int J Pancreatol 3:273–281

    CAS  PubMed  Google Scholar 

  11. Andersson R, Andren-Sandberg A (2003) Fatal acute pancreatitis. Characteristics of patients never reaching hospital. Pancreatology 3:64–66

    Article  PubMed  Google Scholar 

  12. Tsokos M, Braun C (2007) Acute pancreatitis presenting as sudden, unexpected death: an autopsy-based study of 27 cases. Am J Forensic Med Pathol 28:267–270

    Article  PubMed  Google Scholar 

  13. Tumer AR, Dener C (2007) Diagnostic dilemma of sudden deaths due to acute hemorrhagic pancreatitis. J Forensic Sci 52:180–182

    Article  PubMed  Google Scholar 

  14. Enquist IF, Gliedman ML (1958) Gross autopsy findings in cases of fatal acute pancreatitis. AMA Arch Surg 77:985–991

    CAS  PubMed  Google Scholar 

  15. Gardner TB, Vege SS, Chari ST et al (2009) Faster rate of initial fluid resuscitation in severe acute pancreatitis diminishes in-hospital mortality. Pancreatology 9:770–776

    Article  PubMed  Google Scholar 

  16. Di Maio VJ, Di Maio DJ (1991) Natural death as viewed by the medical examiner: a review of 1000 consecutive autopsies of individuals dying of natural disease. J Forensic Sci 36:17–24

    CAS  PubMed  Google Scholar 

  17. Storck G, Pettersson G, Edlund Y (1976) A study of autopsies upon 116 patients with acute pancreatitis. Surg Gynecol Obstet 143:241–245

    CAS  PubMed  Google Scholar 

  18. Eland IA, Sturkenboom MJ, Wilson JH et al (2000) Incidence and mortality of acute pancreatitis between 1985 and 1995. Scand J Gastroenterol 35:1110–1116

    CAS  Article  PubMed  Google Scholar 

  19. Goldacre MJ, Roberts SE (2004) Hospital admission for acute pancreatitis in an English population, 1963–98: database study of incidence and mortality. BMJ 328:1466–1469

    Article  PubMed  Google Scholar 

  20. Lindkvist B, Appelros S, Manjer J et al (2004) Trends in incidence of acute pancreatitis in a Swedish population: is there really an increase? Clin Gastroenterol Hepatol 2:831–837

    Article  PubMed  Google Scholar 

  21. Andersson B, Olin H, Eckerwall G et al (2006) Severe acute pancreatitis—outcome following a primarily non-surgical regime. Pancreatology 6:536–541

    Article  PubMed  Google Scholar 

  22. Renner IG, Savage WT 3rd, Pantoja JL et al (1985) Death due to acute pancreatitis. A retrospective analysis of 405 autopsy cases. Dig Dis Sci 30:1005–1018

    CAS  Article  PubMed  Google Scholar 

  23. Mole DJ, Olabi B, Robinson V et al (2009) Incidence of individual organ dysfunction in fatal acute pancreatitis: analysis of 1024 death records. HPB (Oxford) 11:166–170

    Google Scholar 

  24. Gallerani M, Boari B, Salmi R et al (2004) Seasonal variation in the onset of acute pancreatitis. World J Gastroenterol 10:3328–3331

    PubMed  Google Scholar 

  25. Martinez J, Johnson CD, Sanchez-Paya J et al (2006) Obesity is a definitive risk factor of severity and mortality in acute pancreatitis: an updated meta-analysis. Pancreatology 6:206–209

    CAS  Article  PubMed  Google Scholar 

  26. Blomgren KB, Sundstrom A, Steineck G et al (2002) Obesity and treatment of diabetes with glyburide may both be risk factors for acute pancreatitis. Diabetes Care 25:298–302

    CAS  Article  PubMed  Google Scholar 

  27. Ellis MP, French JJ, Charnley RM (2009) Acute pancreatitis and the influence of socioeconomic deprivation. Br J Surg 96:74–80

    CAS  Article  PubMed  Google Scholar 

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Affiliations

  1. Department of Surgery, Clinical Sciences Lund, Lund University and Lund University Hospital, S-221 85, Lund, Sweden

    Bodil Andersson, Daniel Ansari, Ellen Andersson & Roland Andersson

  2. Department of Forensic Medicine, Lund, National Board of Forensic Medicine, Lund, Sweden

    Sixten Persson

Authors
  1. Bodil Andersson
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  2. Daniel Ansari
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  3. Ellen Andersson
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  4. Sixten Persson
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  5. Roland Andersson
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Correspondence to Bodil Andersson.

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Andersson, B., Ansari, D., Andersson, E. et al. Fatal Acute Pancreatitis Occurring Outside of the Hospital: Clinical and Social Characteristics. World J Surg 34, 2286–2291 (2010). https://doi.org/10.1007/s00268-010-0693-z

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  • DOI: https://doi.org/10.1007/s00268-010-0693-z

Keywords

  • Acute Pancreatitis
  • Severe Acute Pancreatitis
  • Pancreatic Necrosis
  • Blood Alcohol Concentration
  • Socioeconomic Deprivation