A 50 year old woman complained of a six day history of increasing abdominal pain. She was found unresponsive in bed by her husband. At autopsy, she had a vitreous glucose of 900 mg/dL and just a teeny bit of acetone. Examination of the gallbladder revealed no bile, but it was sclerosed around two large smooth pale green stones, measuring 1.8 and 2.2 cm respectively. Examination of the pancreas revealed it to be necrotic and hemorrhagic with a 3 cm hemorrhagic cyst near the tail. There was a sharp demarcation between remaining relatively normal pancreas and the large area of necrosis:
On histologic examination, there were broad areas of coagulative necrosis and necrobiosis, with a mixed acute and chronic inflammatory cell infiltrate (mostly mononuclear). The splenic artery was thrombosed.
Here’s the panorama pic. The remnant of viable pancreatic tissue is on the right:
Here’s a closer view with the viable pancreas on the right:
A thrombosed vessel:
Some fat necrosis in the surrounding adipose tissue:
Examination of the gallbladder revealed chronic cholecystitis:
While I found stones in the gallbladder, I didn’t find anything in the ducts. That doesn’t bother me. With over a week of symptoms, she may well have passed it once the pancreatitis started snowballing. About 80 percent of acute necrotizing pancreatitis comes from either gallstones or alcohol use. There was no alcohol use in this case.