Infarction and apoplexy of the pancreas: causes, symptoms, diagnosis, treatment

Causes, pathogenesis. In some cases, especially with pronounced widespread atherosclerotic vascular lesions in elderly and senile individuals, thromboses and infarctions of the pancreas sometimes occur. They can be caused by small thrombi and emboli from the left atrium in case of heart defects (stenosis of the left atrioventricular orifice), infective endocarditis, emboli from an atheromatous plaque, etc. It is believed (and this, as a rule, occurs in real life) that in these cases emboli also enter various other organs: the kidneys, spleen, liver, etc. It is believed that provoking factors in embolism of the contents of an atheromatous plaque can be treatment with anticoagulants, aortography, since these factors contribute to the detachment of contents from atheromatous atherosclerotic plaques. This type of embolism can be suspected in patients with widespread severe atherosclerosis (atheromatosis) of the aorta in combination with arterial hypertension.

Pathomorphology. Apoplexy and infarction of the pancreas, at least at the beginning of the process development, differ from acute hemorrhagic pancreatitis according to morphological criteria by the limited, strictly focal nature of the hemorrhagic process. The tissue of the pancreas during infarction and apoplexy outside the focus (focuses) of hemorrhage remains intact, as does the retroperitoneal tissue surrounding the gland. In hemorrhagic pancreatitis, the entire tissue of the pancreas is in a state of pronounced inflammation and necrosis, is saturated with blood (hemorrhagic pancreatitis); hemorrhagic impregnation also affects the retroperitoneal tissue surrounding the pancreas.

Symptoms, diagnostics. The clinical picture of acute circulatory disorders of the pancreas such as hemorrhage or thromboembolism is vivid: the main symptom is the sharpest pain in the area of the pancreas, accompanied by a collapsed state and sharp pain in the area of the gland. The activity of pancreatic enzymes in the blood serum and urine usually does not change in the first hours.

Urgent non-contrast abdominal radiography can reveal calcium salt deposits in the aorta, sometimes calcifications of the pancreas itself (traces of past hemorrhages or embolism), calcium deposits as a result of long-term chronic pancreatitis. In some cases, ultrasound can reveal, in addition to edema and often sclerosis (in elderly people), unevenness of the pancreatic tissue. However, one should remember the severe pain that occurs when the pancreas is damaged, which in itself makes it difficult to perform any minimally long examination, requiring at least a short-term completely motionless position of the patient (without sufficiently strong analgesia).

Without further treatment, the prognosis in many cases is poor.

Treatment. Conducted in the surgical department of a hospital according to the general principles of treatment of acute hemorrhagic pancreatitis. In cases of suppuration and sequestration of areas of hemorrhagic lesion of the pancreas, highly active antimicrobial drugs with a broad spectrum of action and surgical treatment are indicated. In all cases of vascular lesions of the pancreas, one should not lose sight of the state of its second extremely important function - the endocrine one, especially in severe cases of the disease. It is necessary to monitor the state of carbohydrate metabolism (the more severe the patient's condition, the more often - every 3-4 hours, then daily: blood and urine tests); if any deviations are detected, they should be corrected immediately. When the patient's condition improves, the underlying disease and lesion of the pancreas are treated (according to the principles of treatment of subacute and chronic pancreatitis).

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