PANCREAS - Acute haemorrhagic pancreatitis

Pancreas showing a portion of the duodenum. The pancreas is considerably enlarged by extensive haemorrhage, and shows marked fat necrosis as is apparent in the adjacent fat.
This man was admitted with epigastric pain and shock, and in renal failure. Serum amylase 7600 units. He died some seven days after admission. At autopsy, a litre of blood-stained fluid was found in the peritoneal cavity, with 200 ml. of similar fluid in each chest cavity. There was extensive fat necrosis of the omentum and mesentery, the anterior abdominal wall, the diaphragm and the lateral thoracic wall. There were gallstones present. Microscopy of the liver showed a pericholangitis.