Inflammation Case Studies


CASE 6: Fat necrosis of pancreas


Clinical History:

A 53-year-old man was the driver of a car involved in a head-on collision with another vehicle at 45 mph. He was not wearing a seat belt and his vehicle did not have an airbag. He sustained blunt trauma to the upper abdomen. On admission to hospital, he complained of severe abdominal and mid-back pain. He appeared gravely ill. A peritoneal lavage revealed bloody abdominal fluid. Serum lipase was 7500 U/L. At surgery, multiple liver lacerations were noted, and there were flecks of white, chalky material in adipose tissue adjacent to a slightly swollen pancreas.
  1. Diagnose and describe what you see grossly and microscopically.

    2. This is fat necrosis. Scattered tan areas are seen throughout the pancreas. There is not much of a neutrophilic exudate, but the adipose tissue shows areas of necrosis that are smudgy, amorphous, and pink to violaceous (compare with normal adipose tissue).

  2. How does this lesion occur?

    3. The blunt force traumatic injury (probably from the steering wheel) damaged the pancreas so that pancreatic enzymes (lipases) were released and began to digest surrounding tissues. Thus, fatty acids released from triglycerides combined with calcium to produce the white, chalky, soap-like material typical of fat necrosis.

  3. Name another site at which trauma can produce this lesion.

    4. Trauma to the breast may produce fat necrosis.