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
Catalogue details

Licence: Public Domain Mark

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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    Fatty degeneration and fatty infiltration of the pancreas were not necessarily j)resent in these cases, and frequently occur without a trace of hemorrhage. The seat, extent, and rapidity of the bleeding suggest that it is rather arterial than venous, and no evidence of venous obstruction has l)een found. Such hemorrhages Jire most likely to be of aneuris- mal origin, but aneurisms have not been discovered. An embolic source luis been sought for in vain. It is possible that the pancreatic secretion may have corrosive properties, as suggested by Klebs, in which case the ('ondition should occur oftener. Suggestive evidence in favor of this view is the fact, well-known to demonstrators of anatomy, and called to my attention by my colleague, Dr. Mixter, that arterial injections are likely to break through and esca})e in the region of the pancreius. Hemorrhages in a di.seased or dead pancreas might be thus exj)lained, but in the great majority of the cases collected there is no sufficient evidence of such disease. It is also possible that the hem- orrhage may be of nervous origin, as in the imlmo- nary infarctions sometimes associated with cerebral lesions. The only fact in favor of this view is the associa- tion of such pulmonary nodules with the pancreatic hemorrhages in one case. This observation, com- pared with the relative frequency of ])ulmonary hemorrhages of apparent central, nervous origin, makes the single instance of but little value as evidence. That fat-necrosis is not a cause for such hemor- rhage is obvious from its presence being suggested only in a single instance. It is evident that the first step towards a more accurate knowledge of the immediate cause of this affection must lie in a more careful search for the actual source or sources of the leak.