For fat pancreonecrosis, the pattern of rapid formation of an inflammatory infiltrate in the region of the left hypochondrium and epigastrium is typical, but it is possible to clearly reveal the infiltrate only on the 4th-5th day after the onset of the disease. If the disease has a recurrent nature, it is likely that the infiltrate will manifest much later. This form of pancreatic necrosis is formed with the participation of lipase in the inflammatory process. Progresses this type of necrosis very slowly, gradually involving in the inflammatory process peripancreatic tissues and located in the fascial abdominal organs. This development of the disease contributes to the emergence of parapancreatic infiltrate, which prevents the manifestation of pancreatogenic peritonitis and the appearance of peritoneal effusion. In addition to lipase in the development of fat necrosis, an important role is played by a proteolytic enzyme such as elastase, which is also produced by the pancreas. A distinctive feature of elastase is the possibility of causing extensive bleeding, destroying the walls of blood vessels. Also, in patients with this form of pancreatic necrosis, fluctuations in the enzyme alpha-amylase are noted, but changes in its amount do not play an important role in the pathological process of fatty pancreatonecrosis formation. At the same time, pathobiochemical shifts in proteolytic and lipolytic enzyme systems of the gland, thrombin, plasmin, sympathic-adrenal and kallikrein-kinin systems take the leading pathogenetic role in the development of this type of necrosis.
It is possible to determine whether the patient suffers with this particular form of pancreatic necrosis by examining the large and small omentum, the visceral and parietal peritoneum for foci of fat necrosis.
Fatty form of pancreatic necrosis, as a separate disease, occurs only in every twentieth patient suffering from pancreatic necrosis. Most often, the fatty factor of pancreatic necrosis acts as a related disease such as:
- hemorrhagic with fatty necrosis;
- fatty pancreonecrosis with hemorrhage.
If the patient is hemorrhagic with fat necrosis, then we should expect the appearance of signs of an organism disorder in: peripheral and central hemodynamics of the patient with the addition of enzymatic peritonitis.
In the case of a combination of fatty and hemorrhagic pancreonecrosis, a distinctive feature of this form of necrosis will be the appearance in the epigastrium of the inflammatory process already at the early stages of the development of the disease.