| Total replacement of the exocrine pancreas with fat following multiple blunt injuries. | |
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MedLine Citation:
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PMID: 20593603 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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We describe an unusual case of total replacement of the exocrine pancreas with fat, which was observed in an autopsy of an assaulted victim. A woman in her early 80s was kicked, stamped and hit several times with firewood. She was hospitalized with disturbance of consciousness, left haemothorax and multiple fractures, and died about three months later. Postmortem examination revealed extensive abrasions and bruises, multiple fractures and internal organ injuries such as contusion and haemorrhage, as well as bronchopneumonia. It was concluded that the cause of her death was hypostatic pneumonia followed by traumatic shock due to multiple blunt injuries. Further, complete replacement of the pancreas with fat was observed in addition to a calculus in the main pancreatic duct and fibrous hypertrophy of the ductal wall. Histopathological examination revealed almost complete replacement of the pancreatic acini by fat tissue, whereas the islets of Langerhans were mostly intact. Antemortem laboratory data showed that serum amylase levels were almost within normal range before hospital admission, but underwent a transient abnormal elevation at admission followed by extremely low levels thereafter. Previous reports suggest that obstruction of both the main pancreatic duct and the artery, due to tumour formation or calculus in combination with arteriolar sclerosis, are necessary to induce total replacement of the pancreas with fat. Since arteriolar sclerosis was not remarkable in this case, we speculated that pancreatic ischaemia due to circulatory disturbance caused by traumatic shock, in combination with pre-existing calculus, may have contributed to the development of total replacement with fat. The temporal alterations in serum amylase levels support our speculation. There are few, if any, reports regarding organ replacement with fat in association with trauma. This case suggests that multiple injuries followed by traumatic shock may advance pre-existing replacement of the pancreas with fat. |
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Authors:
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Takahito Hayashi; Aichi Yoshida; Kazutoshi Ago; Mihoko Ago; Mamoru Ogata |
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Publication Detail:
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Type: Case Reports; Journal Article |
Journal Detail:
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Title: Medicine, science, and the law Volume: 50 ISSN: 0025-8024 ISO Abbreviation: Med Sci Law Publication Date: 2010 Apr |
Date Detail:
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Created Date: 2010-07-02 Completed Date: 2010-07-22 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0400721 Medline TA: Med Sci Law Country: England |
Other Details:
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Languages: eng Pagination: 103-6 Citation Subset: IM |
Affiliation:
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Department of Legal Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan. takahito@m2.kufm.kagoshima-u.ac.jp |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adipose Tissue
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pathology* Aged, 80 and over Amylases / blood Female Forensic Pathology Homicide Humans Pancreas, Exocrine / pathology* Shock, Traumatic / complications* Wounds, Nonpenetrating / complications* |
| Chemical | |
Reg. No./Substance:
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EC 3.2.1.-/Amylases |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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