The morphological basis for the evolution of acute pancreatitis into chronic pancreatitis

Conclusions There are many reasons to believe that the necrosis-fibrosis sequence is the basic pathogenetic event in the evolution of chronic pancreatitis. This sequence implies that acute pancreatitis, probably in its severe relapsing form, may be the cause of chronic pancreatitis. To make this concept relevant to the individual patient and the natural course of his/her disease, the extent and distribution pattern of necrosis in acute pancreatitis has to be carefully evaluated with regard to the restitutional processes (i.e. restitutio ad integrum, pseudocyst, intrapancreatic fibrosis) that may follow. Such an analysis reveals that only after severe acute pancreatitis and only under certain conditions, such as the occurrence of intrapancreatic necrosis involving the main duct, development of chronic pancreatitis can be anticipated. The individuality of each patient's pancreatitis demands a thorough clinical and morphological assessment of the pancreas in order to assign the appropriate therapy to this disease and halt its progression (Warshaw 1990).