Acute pancreatitis : a consideration of pancreatic hemorrhage, hemorrhagic, suppurative, and gangrenous pancreatitis, and of disseminated fat-necrosis : the Middleton-Goldsmith lecture for 1889 / by Reginald H. Fitz.

Reginald Heber Fitz

Date:: 1889

Credit: Acute pancreatitis : a consideration of pancreatic hemorrhage, hemorrhagic, suppurative, and gangrenous pancreatitis, and of disseminated fat-necrosis : the Middleton-Goldsmith lecture for 1889 / by Reginald H. Fitz. 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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$For s«‘v*'ial nuinths l>efore the pati«‘nt's death a tumor \va.s noticed in the epigastric and right hy|XK'honfIriac regions. There wen^ also sigpis of advanced phthi.sis. The ]>fitient sat n]> every day until a short time l>ef(m* his death. The day before this took plajx* he was fomul {tartiallv comatose. The tumor wju* a <*yst of the j>an<*r»‘a.s, containing from ten to fourteen ounces of V»io<Klyd(H)kiMg, serous Huid without coagula. The conspicuously hemorrhagic (‘ont-iuits of pan- creatic cysts have also Ih*ch noticed hv Anger,^® KUster,** Hull/* K.sher,** Wdltler.** Hagenhar-h/^ and Steele.*’ The case rejM^rt^il by Hep])er** a« one of fatd hemorrhage from a j>ancreatic cyst a4lmits of another exjdanation. The |>atient, an internj)crat4‘ man. had frcfjuently recurring, int«*s- tinal hemorrhages for six months, lie hatl two atta('ks of blotKly vomit within five week.s, and finally an attack of g;i.stro-int<‘8tinal hemorrhage, proving fatal in an hour. The blood c.«»me tlmmgh an ojxMiing in the duodenum, a half-inch in <liam- eter, near the common duct. A proU*. pjisscd thn>ugh the ojaming. cntere<l a cavity in the hea^l of the j)ancreas, of the size of a walnut. Its walls wert‘ tralH'culated, but “everywhen' covered by a smooth mucous membnine.” numeious crystals of ha'inatiTie Avere lying oji the surface. “ Hut little of the j)r(»jHT gland-tissue to 1«‘ seen in this j»art of the orgjin. its ^il.ace having l«*en apparently usuijM'd b\- dense, hbn)us tissue. The same state affairs is .also obscrA’abh^ in the IkkIv’ and tail of the gland, although in a le.s.H marked degree.” It seems mon* probable, from the symptoms in this ca.se, the seat of the cavity, the nature of the dmv denal oiwning, ami the history of pancnsitic cysts, that thi.s wa.s rathi'r a ca.se of |K*rforating, dufxienal ulcer with corro.siou of the p.ancn*.'us. than of j>an- cn'atic «*yst oisuiing into the iluodenum. *• Moll. Sk>c. Aiiat. <l«> I'arifi. 18C.r», xl. Hr.!. ** lt*>rliitcr kliii. WtxSi., 1SS7. lx. Ii'i4. ** N. V. .\1. .1., 1HS7, xlTl. 370. o CoiTMii. bl. t. Sebweixer A«rzte, 18H8, llritUU M. J.. 1S8S. I. I‘3'.t7. ... . . ** Z«>iUelir. t. isss, ix I lit. l»..oi»<li« Z«iu« iir. t. t'hirunrle, 1HM8. ixxU. 110 «» Cliiriiffu M. .1, Kiul K«Bm., 1H8S, l»i 205. « eroce<Hliii|(i null*. l*«Ui. Sim;., 1870, ili. 182.$