Surgeons in the Democratic Republic of the Congo opened a 31-year-old man's abdomen with a perforated stomach ulcer still on their list of possibilities. They found a large collection of blood, a swollen and bleeding pancreas, and scattered white plaques on the fatty tissue around his intestines that looked like drips of candle wax.
The surgeons, from the Université Officielle de Mbujimayi, published photographs of the findings on Aug. 31, 2026, in the Pan African Medical Journal. They describe "multiple whitish plaques" on the omentum and mesentery, with "the classic 'candle-wax' appearance consistent with enzymatic fat necrosis." These are spots where the man's own pancreatic enzymes had broken down his abdominal fat.
A Patient in Shock and a Difficult Call
The man had been in acute abdominal pain for 48 hours. He arrived in shock, very pale, with abdominal guarding, a tensing of the belly muscles that can signal a serious problem inside. He had a history of alcohol use. His hemoglobin was 8 g/dL, a sign of anemia, and his urea and creatinine, markers of kidney function, were elevated. His serum lipase, an enzyme that rises when the pancreas is inflamed, was markedly increased.
An ultrasound showed fluid in his abdomen but no gallstones. Doctors diagnosed alcohol-induced acute pancreatitis, with a perforated stomach ulcer, which needs emergency repair, as the main alternative diagnosis. He then underwent emergency exploratory surgery.
That sequence stands out against current practice for the most serious form of the disease. An American Gastroenterological Association clinical practice update on pancreatic necrosis says dead pancreatic tissue should not be surgically removed in the first two weeks and that removal should ideally be delayed for four weeks or more. It favors a gradual step-up approach that starts with drainage and moves to surgery only if needed, and it prefers minimally invasive operations over open surgery when possible because they cause fewer complications. In this case, the operation was exploratory, and the waxy deposits were found along the way.
Fat Turned Into Soap
The candle-wax look comes from chemistry. When the inflamed pancreas leaks digestive enzymes into surrounding tissue, lipase breaks down nearby fat. The freed fatty acids then bind to calcium and form a chalky, soap-like material. The process is called saponification, the same basic reaction used to make soap.
The NIH-hosted reference StatPearls describes how released pancreatic enzymes liquefy fat cells in the abdominal cavity, which "then combine with calcium and are identified as chalky white areas."
Because the reaction uses up calcium, it can affect the rest of the body. Another StatPearls chapter lists pancreatitis "due to fat saponification" among the acute causes of low blood calcium.
The surgeons evacuated the blood, rinsed the abdominal cavity thoroughly and placed drains. They report that his early recovery was complicated by "severe oligo-anuric renal failure," meaning his kidneys were producing little or no urine. The report does not describe what happened to him afterward.
When Pancreatitis Bleeds
Most cases of acute pancreatitis are far milder. The National Institute of Diabetes and Digestive and Kidney Diseases(NIDDK) says there are about 275,000 hospital stays for acute pancreatitis in the United States each year, and that most people get better within several days with treatment. NIDDK also notes that men are more likely than women to develop pancreatitis.
According to StatPearls, about 80% of patients have mild disease, and overall mortality is around 1% to 2%. That figure rises to about 20% in necrotizing forms. Gallstones and biliary sludge cause about 35% to 40% of U.S. cases, and alcohol about 17% to 25%. Bruising around the navel or along the flanks, known as Cullen and Grey Turner signs, can point to bleeding in hemorrhagic pancreatitis.
This man showed several warning signs of a serious attack: shock, anemia, elevated kidney markers and, after surgery, kidney failure. Doctors grade severity using the revised Atlanta classification. Mild pancreatitis involves no organ failure and no local or systemic complications. Organ failure that resolves within 48 hours, or complications without persistent organ failure, makes it moderately severe. Organ failure lasting more than 48 hours marks severe acute pancreatitis. The report does not give enough detail to formally grade his case.
A Classic Finding, Seen Up Close
Fat necrosis in pancreatitis is a familiar finding to surgeons and pathologists, and the authors describe its appearance as classic. The photographs show what it looks like inside a living patient during an acute, bleeding attack.
The report is a single clinical image, not a study, and it leaves out details such as CT findings and the patient's outcome. Its value is as a teaching image, showing that a severe pancreatitis attack can damage tissue well beyond the pancreas itself.
Anyone with sudden, severe upper abdominal pain, especially pain that spreads to the back or comes with vomiting, fever, or lightheadedness, should seek emergency care.
Key Questions Answered
What did the surgeons find?
White, waxy plaques on the omentum and mesentery, the fatty tissues in the abdomen. These were areas of fat necrosis caused by acute hemorrhagic pancreatitis.
Why does fat necrosis look like candle wax?
Pancreatic enzymes break down fat, and the released fatty acids combine with calcium. This forms chalky, soap-like deposits in a process called saponification.
Why did the man have surgery?
He was in shock with abdominal guarding, and a perforated stomach ulcer, which requires emergency surgery, was the main alternative diagnosis.
Is surgery usually done for acute pancreatitis?
Not early on. Guidance on necrotizing pancreatitis advises delaying removal of dead tissue for about four weeks and favors a step-up, minimally invasive approach.
Can fat necrosis affect blood calcium?
Yes. Saponification uses up calcium and can cause low blood calcium in pancreatitis.
How common is acute pancreatitis?
NIDDK estimates about 275,000 U.S. hospital stays a year. StatPearls says about 80% of patients have mild disease.
Published by Medicaldaily.com
