Abstract
Pancreatic ischemia and arterial occlusion due to the formation of microthrombosis in the pancreatic vessels caused by the up-regulation of coagulability may have an important role in the development of mild pancreatitis into necrotizing pancreatitis. Recently, vasospasm has been noticed as a cause of exacerbation of acute pancreatitis. Angiography of abdominal vessels in the early phase of acute necrotizing pancreatitis showed ischemic changes with vasospasm in accordance with the poorly perfused area of the pancreas detected by CE-CT. Severe ischemic changes on angiography were primarily observed in patients in whom more than 50% of the pancreas was poorly perfused. The extent of the ischemic changes with vasospasm was correlated with the extent of the poorly perfused area of the pancreas and the mortality rate. Non-occlusive mesenteric ischemia is often accompanied by severe acute pancreatitis, and severe vasospasm occurred in both the celiac artery and the superior mesenteric artery and their branches simultaneously. These findings demonstrate that vasospasm is a major cause of pancreatic ischemia in acute necrotizing pancreatitis.
