Figure 10

Natural history of alcoholic pancreatitis. Mild acute pancreatitis is characterized by spotty peripancreatic fat necrosis, which is resolved without inducing significant fibrosis. Severe acute pancreatitis with large confluent areas of peripancreatic necrosis, but little intrapancreatic involvement, leads to an extrapancreatic pseudocyst. Relapse of severe acute pancreatitis with extensive extra- and intrapancreatic foci of necrosis induces perilobular fibrosis and duct distortions. In addition, there may be extrapancreatic pseudocysts. Early stage chronic pancreatitis evolve into end-stage chronic pancreatitis with severe duct changes, diffuse but still patchy fibrosis and calculi (adapted from Klöppel⁷³).