[Microcirculatory disturbance in the course of acute pancreatitis]

Although as many studies are sacrificed to acute pancreatitis (AP), the pathogenesis of the disease remains undiscovered. The microcirculatory disturbances during AP as a cause of necrotic changes in the parenchyma of the gland, described first time by Panum in 1886, have become again a very attractive theory. In the last decades, several studies were done to prove that microcirculatory impairment plays a crucial role in pathogenesis of severe AP. It had been proved that many mediators play important roles in this process including nitric oxide and endothelin balance. Vasoconstriction and vasodilatation named "vascular game" caused by cytokine accumulation and lower oxygenation of the tissue gives very interesting basis for theories about creating pancreatic necrosis. The severity of the course of AP also determinates damage of the microcirculation of the lungs, the liver and the bowels which leads to SIRS, MODS and MOF. The new experimental dates seems to be very promising and can became a basis for developing a new strategy of treatment in the most severe cases of AP. In this article we present up-to-date information about these theories and concepts.