Gross and Histopathological Changes in Pancreas in Cases of Death Due to Thermal Burn Injury: A Cross-sectional Autopsy-based Study

Thermal burns trigger complex systemic inflammatory and metabolic responses that may affect organs, including the pancreas, yet pancreatic pathology in burn-related deaths is poorly documented. This study evaluated gross and microscopic pancreatic changes in 63 medicolegal autopsies of fatal thermal burn cases and explored their relationship with total body surface area (TBSA) involvement and survival duration after injury. Gross examination commonly revealed congestion (42.9%) and necrosis (23.8%). On histopathology, congestion (52.8%) and necrosis (44.4%) were the predominant findings, along with varying degrees of edema, haemorrhage, fibrosis and inflammatory infiltrates. Pancreatic necrosis was minimal or absent in individuals who died within 72 hours of sustaining burns, but its frequency and severity increased with longer survival, particularly beyond 97 hours. Moderate to severe necrosis was more evident in patients surviving more than one week. Interestingly, higher grades of necrosis were observed more often in moderate burns (30–50% TBSA) than in extensive burns involving more than 50% TBSA. Statistical analysis did not demonstrate a significant association between pancreatic necrosis and either TBSA ( p = 0.289) or survival duration ( p = 0.867). However, Spearman correlation analysis revealed a weak but significant positive correlation between necrosis grade and survival duration ( r = 0.284, p = 0.024). These findings suggest that pancreatic necrosis in burn victims may represent a delayed consequence of sustained systemic inflammation or metabolic derangement rather than an immediate effect of thermal injury.