Clinical and pathological features of acute interstitial pancreatitis in the aged

Histological examination of the pancreas disclosed acute diffuse interstitial pancreatitis in nine cases (0.62%) out of 1457 autopsies performed in 3 yr at two general hospitals in Tokyo. In this series, there were 11 cases of necrotizing or hemorrhagic pancreatitis. In addition to diffuse phlegmonous inflammation, acute interstitial pancreatitis was characterized by rupture of the ducts and ductules associated with profuse intraluminal exudation of polymorphonuclear leukocytes and protein plugs formation. There was scarce parenchymal or fat necrosis. The interstitial type may represent characteristics of acute pancreatitis in the aged. In all nine cases, there were few clinical signs suggestive of acute pancreatitis, except for shock, that developed rapidly. Duration of the disease was rather short. Diagnosis of acute pancreatitis was not made before death. In five patients, acute pancreatitis was terminally superimposed on other serious ailments. But in the other four cases, acute pancreatitis was disclosed as the primary disease at autopsy. Although there was only one case that had a possibility of being secondary to biliary tract infection, ascending bacterial infection and impaired secretion by atrophic parenchyma seemed to be involved in its pathogenesis.