Necrotizing pancreatitis is caused by severe acute pancreatitis that leads to tissue death (necrosis) in the pancreas. The main causes and contributing factors include:
- Gallstones : The most common cause, where gallstones block the pancreatic duct, causing inflammation and enzyme activation inside the pancreas, which damages pancreatic tissue
- Excessive alcohol consumption : Chronic heavy drinking is the second leading cause and can trigger severe inflammation and necrosis in the pancreas
- Other causes : Trauma to the pancreas, high blood calcium (hypercalcemia), high triglyceride levels (hypertriglyceridemia), pancreatic tumors, autoimmune diseases, genetic conditions (such as cystic fibrosis), and medication side effects can also lead to necrotizing pancreatitis
The pathophysiology involves inappropriate activation of pancreatic digestive enzymes within the pancreas itself, which normally should be inactive until reaching the intestines. This enzyme activation causes the pancreas to digest itself, leading to inflammation, ischemia (lack of blood flow), and eventually necrosis of pancreatic tissue
. Severe inflammation also triggers a systemic inflammatory response that can worsen pancreatic damage and cause complications like infection of necrotic tissue, sepsis, and organ failure
. In summary, necrotizing pancreatitis typically arises from gallstone obstruction or alcohol-induced acute pancreatitis that progresses to severe inflammation, enzyme activation, ischemia, and pancreatic tissue death. Other metabolic, traumatic, autoimmune, and genetic factors can also contribute.
