Sudden death due to acute pancreatitis: Autopsy observations

Acute pancreatitis is a protean disease which is usually mild and self limiting in most cases. The disease is severe and is associated with a high mortality in 5–20% of cases due to systemic complications culminating in multi-organ failure and shock.

Acute pancreatitis (AP) in a subset of patients presents as sudden unexpected death and is diagnosed for the first time during autopsy. The majority of cases of sudden unexpected death can usually be attributed to a past history of illness, clinical features or characteristic findings on postmortem examination. The forensic pathologist or the medical examiner faces the daunting task of determining the cause of death in those cases without any antecedent causes, suspected violence, suicide or homicide and with no clinical history of illness.

Acute pancreatitis is not an uncommon cause of sudden death. We herein report five cases of acute hemorrhagic pancreatitis from the Forensic Pathology Unit of University Malaya, Kuala Lumpur, Malaysia. Two patients presented as sudden death at home while three others died within 24 hours of hospitalization.

All five patients had similar findings of acute hemorrhagic pancreatitis on post mortem examination. Pancreatitis associated organ failure was one of the most important determinants of mortality. Clinical correlates of organ failure included respiratory distress, hypotension and anuria. While biliary etiology represents the main cause in various clinical studies, it had an insignificant role in our five cases of sudden death undergoing medico-legal autopsy. Etiological factors included alcoholism in one and idiopathic causes in four patients. Autopsy based studies provide valuable information and a holistic approach to the study of acute pancreatitis.