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Year 2018 Vol. 26 No 1


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Brest Regional Hospital 1,
Brest Region Directorate of the State Forensic Examination Committee of the Republic of Belarus 2, Brest,
The Republic of Belarus

Objective. To study the nature of pathomorphological changes in the retroperitoneal tissue in the early phase of acute necrotizing pancreatitis.
Methods. The article presents the results of the histological examination of biopsy specimens of the retroperitoneal tissue of 22 patients with acute necrotizing pancreatitis, who were treated with early laparoscopic drainage of the retroperitoneal tissue performed in the first 5 days after the disease onset. The use of biopsy material allowed studying the morphological changes in the retroperitoneal tissue at the earliest stages of the disease.
Results. The analysis of the obtained results revealed a number of features of the inflammatory reaction in the retroperitoneal tissue in acute pancreatitis. First of all, it is a delayed exudative inflammatory reaction when an immediate increase of the vascular wall permeability for the blood cells did not occur. Microvascular reactions were delayed confirmed by the late (after 48 hours) occurrence of small-focal hemorrhages and fibrin deposits. There were practically no thromboses at the microcirculatory level. The peculiarity of cellular reactions in the first 2 days was the dominance of lymphocytes. The leukocyte round cell infiltration was detected, which indicates a serous nature of the inflammatory reaction. Starting with the second day, there were single polynucleous leukocyte infiltrates, being a morphological sign of a suppurative inflammation. Their amount progressively increased with the prolongation of the disease terms. Fat necrosis was detected 48 hours after the disease onset.
Conclusions. The lesion of the retroperitoneal tissue occurred much later than the manifestation of acute necrotizing pancreatitis. Pathomorphological changes in the retroperitoneal tissue in the early phase of acute pancreatitis are subject to evolution and have staging, determined by the duration of the impact of disturbing factors. The nature of the inflammatory reaction reflects a consistent transition from serous inflammation to purulent one. The obtained data show a pathogenetic foundation to apply early draining operations using minimally invasive technologies in the first 48 hours in the stage of serous inflammation, when pathological changes in the retroperitoneal tissue are potentially reversible.

Keywords: acute necrotizing pancreatitis, retroperitoneal tissue, biopsy, fat necrosis, laparoscopic drainage, inflammation
p. 34-41 of the original issue
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Address for correspondence:
224027, The Republic of Belarus,
Brest, Meditsinskaya Str.,7,
Brest Regional Hospital,
Purulent Surgery Unit,
Tel. office: +375 162 27-21-91,
Belorusets Victor N.
Information about the authors:
Belorusets Victor N., Applicant of the General Surgery Department, Grodno State Medical University, Surgeon of the Purulent Surgery Unit, Brest Regional Hospital, Brest, Republic of Belarus.
Karpitskij Aliaksandr S., MD, Professor, Head Physician, Brest Regional Hospital, Brest, Republic of Belarus.
Golubeva Natalja N., State Medical Forensic Expert of the Department f Forensic Histological Examinations of the Laboratory Examination of Physical Evidence of a Biological Nature of the Brest Region Directorate of the State Forensic Examination Committee of the Republic of Belarus, Brest, Republic of Belarus.
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