Background: The causes of acute pancreatitis are well known, and although enzymatic injury is the main factor in its development, pancreatic ischemia due to profound hypoperfusion in cardiogenic or hypovolemic shock patients can be an important etiological factor. The aim of our study was to analyse the histological alterations of the pancreas in patients dying after shock, to study the presence and severity of pancreatic injury.
Material and methods: We studied the morphological alteration of the pancreas, in patients who died after cardiogenic or hypovolemic shock, hospitalized in intensive care units in the County Emergency Hospital Tîrgu Mureș, between 2007–2009.
Results: We examined the structure of the pancreas of 117 patients, 20 showed acute hemorrhagic pancreatic necrosis on autopsy. None of the patients showed typical clinical and laboratory signs for acute pancreatitis. The common findings in these patients were prolonged and severe hypotension, leucocytosis, hyperglycemia and hypocalcemia.
Conclusions: Pancreatitis can occur in patients with shock, due to ischemic injury of the pancreas. It is difficult to diagnose it because clinical signs are altered by the severity of the underlying disease or by analgo-sedation commonly used in intensive care units. We therefore recommend to consider the possible development of acute pancreatitis in patients with shock, in patients with prolonged hypotension, leucocytosis, hypocalcemia, even in the absence of characteristic clinical symptoms and hyperamylasemia.