The great omentum : notes on its development, anatomy, physiology, and pathology / by W. McAdam Eccles.

  • Eccles, William McAdam, 1867-1946.
Date:
[1895?]
Catalogue details

Licence: Public Domain Mark

Credit: The great omentum : notes on its development, anatomy, physiology, and pathology / by W. McAdam Eccles. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    posterior part of the abdomen, and apparently well protected, is, however, occasionally lacerated by kicks, blows, &c. This laceration will lead to some extravasation of the secre- tion of the organ, and this occurring with some amount of hemorrhage causes irritation, and thus the production of an inflammatory cyst wall. Senn has said that pancreatic fluid is non-irritating to the normal peritoneum, but this does not necessarily hold good in the conditions under which it is poured out in cases of traumatism. [ii.J Inflammation, and consequent stricture of the canal of Wirsung, may occur during or after inflammation of the duo- denum. Stricture of the duct may also possibly result from its laceration. In both cases fluid may collect distally to the narrowed part. [iii.] A cavity containing fluid may be formed by the diges- tive or corrosive action of pancreatic fluid on the tissue of the pancreas which is already the seat of disease. The great omentum will be found lying in front of the cyst in whatever way it may have been caused. A traumatic origin is, however, probably the commonest, and the situation of the fluid in such cases is of great interest. It should here be noted that pancreatic cysts have a great tendency, when caused by traumatism, to have blood extravasated into them. In such cases the fluid may be {a) free within the lesser sac of the peritoneum, and possibly actually distending this cavity pretty considerably. Here in the primary lesion it is probable that the layer of peritoneum forming the posterior wall of the lesser sac was torn, and allowed the extravasation to take place into the cavity in front of it. This view is upheld by Mr. Jordan Lloyd,^ and in support of it he quotes an instance where, on post-mortem examination, he found a considerable portion of the pancreas gangrenous, detached, and free, lying in a collection of fluid contained within the lesser cavity of the peritoneum; 2 (h) or the fluid may be in the loose extra-peri- toneal tissue behind the lesser sac, when it will usually be but little in amount; (c) and lastly, it may be between the layers of the transverse mesocolon. Here this portion of the bowel will be displaced downwards. In the first position the stomach will be stretched over the front of the cyst, while the transverse colon will be pressed backwards. These relations are of importance in the question of diagnosis. 1 British Medical Journal, 1892, vol. ii. p. 1051 2 See f' ' '' ' — — - - vol. xlix 2 See also a valuable paper by''l)r. Theodore Fisher, Guy's Hospital Reports, 1893,