Intrathoracic complications of acute pancreatitis

Acute pancreatitis has an incidence of approximately 50 cases per million of the United Kingdom population and a mortality of 10-18%. Intrathoracic complications have been implicated as the major factor in 22-29% and a contributing factor in a further 29-39% of all deaths. Sixty per cent of deaths occur in the first week of hospital admission and in these the pleuropulmonary complication rate is 94%. In the survivors there is little residual lung damage and the recovery of the pulmonary function is invariably complete. Knowledge of the pleuropulmonary complications of acute pancreatitis may aid with the identification of high risk groups so that supportive measures (including mechanical ventilation) can be implemented early in the course of the illness. This article reviews the major intrathoracic complications of acute pancreatitis (Fig. 1) under the broad headings of: 1. pleural effusion 2. acute pulmonary dysfunction (a) hypoxaemia without pulmonary infiltrates (b) hypoxaemia with pulmonary infiltrates (including the adult respiratory distress syndrome; ARDS).