The Role of the Intestine and Mesenteric Lymph in the Development of Organ Dysfunction in Severe Acute Pancreatitis

It has long been recognized that the intestine has a role in the pathophysiology of acute pancreatitis. Only recently has evidence emerged that lymph draining from the intestine in acute pancreatitis, bypassing the liver and entering the systemic circulation, contributes to the inflammatory response and organ dysfunction. Further research is required to define the compositional changes that occur to mesenteric lymph during acute pancreatitis, determine which elements are toxic, and exploit these as new treatment targets. External diversion of thoracic duct lymph appears to ameliorate systemic inflammation and organ dysfunction. There is also the development of mesenteric lymph targeted treatments to reduce toxicity in acute pancreatitis, to dampen systemic inflammation and decrease the risk and severity of organ dysfunction.