Obstructive Pancreatitis

Obstructive pancreatitis is a form seen in pancreatic tissue at the distal side of duct-obstructive changes. This type is noted in cases of carcinoma of the ampulla of Vater, pancreas head, or pancreas body, and in some cases of pancreatic divism, where pancreatic damage is caused due to the impairment of pancreatic juice outflow [16].

Fibrosis is seen interlobularly in the early stage of obstructive pancreatitis, as in the early stage of CAP (fig. 4a). However, in contrast to CAP, intralobular fibrosis with marked acinar atrophy is also seen in progressed stages of obstructive pancreatitis (fig. 4b). Infiltration of a usually small, but sometimes moderate number of inflammatory cells is seen in fibrotic regions in all stages of obstructive pancreatitis, i.e. inflammatory cells such as neutrophils and macrophages infiltrate the interlobular spaces in the early stages, while they infiltrate both the inter- and intralobular spaces in progressed stages [24]. Dilatation of large pancreatic ducts is also observed in this type of pancreatitis.

Fig. 4. Obstructive pancreatitis by disease stages. a In the early stage, fibrosis is seen mainly interlobularly. HE. X10. b Both inter- and intralobular fibrosis occurs in progressed stages. Also note the moderate amount of inflammatory cells seen in both fibrotic regions. HE. X20.

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