title: A search for acute necrotic pancreatitis in early stages of alcoholic chronic pancreatitis.
abstract: OBJECTIVE
  Various investigators believe that alcoholic chronic pancreatitis is the result of recurrent episodes of acute necrotic pancreatitis. The aim of this work is to study pancreatic histology in early stages of the disease to search for evidence of these acute episodes.
  
  
  METHODS
  Of about 650 patients with alcoholic pancreatitis seen during the 30-year period from 1972 to 2002, 45 underwent surgery for this disease, all within 2 years of clinical onset. Of these 45, tissue samples adequate for study were obtained from 42, and this was the study material. Tissue samples were prepared for histologic examination by standard procedures.
  
  
  RESULTS
  Areas of pancreatic necrosis were seen in tissue samples of only three (7%) of the 42 patients, and in all three cases chronic lesions were also present. No evidence of localized scarring that could be attributed to prior episodes of focal necrotic pancreatitis was found. A typical feature was the patchy distribution of the lesions in largely normal pancreatic tissue. The main lesions observed were perilobular and intralobular fibrosis, dilation of acini and ducts, and protein plugs in dilated ducts surrounded by periductal fibrosis.
  
  
  CONCLUSIONS
  This study shows that, in the early stages of alcoholic chronic pancreatitis, signs of acute necrotic pancreatitis are very infrequent and, when present, they are associated with chronic lesions. These findings suggest that alcoholic pancreatitis begins as a chronic disease.
authors.affiliation: Institutes of Internal Medicine, General Surgery, and Pathology, University of Bologna, St. Orsola Hospital, Italy. gullo@med.unibo.it
authors.forename: Lucio
authors.initials: L
authors.lastname: Gullo
authors.forename: Riccardo
authors.initials: R
authors.lastname: Casadei
authors.forename: Marina
authors.initials: M
authors.lastname: Migliori
authors.forename: Marco
authors.initials: M
authors.lastname: Manca
authors.forename: Luciana
authors.initials: L
authors.lastname: Bastagli
authors.forename: Raffaele
authors.initials: R
authors.lastname: Pezzilli
authors.forename: Donatella
authors.initials: D
authors.lastname: Santini
mesh_terms: D000328:Adult; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications* / Q000473:pathology; D019512:Pancreatitis, Alcoholic / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D050500:Pancreatitis, Chronic / Q000209:etiology* / Q000473:pathology / Q000601:surgery