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| Fig. 19.6 Pancreatic fat necrosis showing classic involvement of the lower legs. Note the desquamation on the patient’s right posterior leg, suggesting that spontaneous discharge is likely. |
Subcutaneous nodules occur on the legs (Fig. 19-6) or elsewhere associated with acute or chronic pancreatitis or pancreatic carcinoma. Visceral fat may also be involved. Although immune mechanisms may play a role in producing this form of fat necrosis, the weight of evidence favors the effects of circulating pancreatic lipase, amylase, and trypsin on subcutaneous fat. The frequent co-occurrence of arthritis with joint fluid analysis revealing free fatty acids is a clinical reminder of the systemic effects of these pancreatic enzymes. Treatment is directed toward the underlying pancreatic disease.
Preiss JC, Faiss S, Loddenkemper C, et al: Pancreatic panniculitis in an 88-year-old man with neuroendocrine carcinoma,
Digestion 66:193–196, 2002.
