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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$The appearances found after death are conspicu- ously the hemorrhage within aiul near the pan- ei-eas. The gland may lx* of normal size or enlarged, and its density may not lx» moditied, or the pancreas may l>e flaccid, soft, and friable. The hemorrhagic infiltration is to Im> found in the sufipf-ritoneal tissue around the pancreas as well as in the int»*r8titial tissue of the gland. 'I'he former may be continued into the omentum and mesentery, l>ehind the colon, and inU> the j»erinephritic fat-ti.ssue. The entire j»anereas may Im’ infiltrated, or either half, or the central |x>rtion alone may lx* conspicuously involved. The hemorrhage is usually diffused, but it may be in numerous jKitches, lK)tli beneatli the }>eritoneal investment and in the interlobular tissue. The color and moisture of the cut .surfa<‘e indicat<» that the extravasation is recent. It may take place into a normal ]Kmciva.s or into one which is either fatty infiltnited, or fatty d<*generated, »)r into one which shows a gnuiular condition of the epithelium. In a single instance evidence of an older hemor- rhage wa.s to Ih? found in the presence of rxiiuid, ortinge-colored bundles of iicicular cystals. In the same p.ancreas were also to Ijo seen colorless, acicular cystahs, probably of fat, in clumps visible to the nake<l eye, eorres{)onding to the appearances to l)c descril)ed under fat-necrosis. The microscopic examinations of one of Draiwir’s ca.ses showed occa- sional i»atches of hemorrhage within the lobule.s, although the infiltration was essentially in the in- terlobular tissue. Hemorrhagt'S might also Ije found in the wall of the duodenum and caecum, and in the lungs in a single instance. Although the splenic arter}^ is reported to have lx‘en tortuous in one case, there is no evidence in any of a circums<Tilx*d aneurism. The splenic vein, when examined, was free from obstruction. The conditions found by Zenker, viz., injection of the fxirtal. venous system and of the capillaries of the solar plexus, with distended and empty car- diac ventricles, were not generally met with.$