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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$was taken to the Massachusetts (Jeneral Mospital, where she died in the course of a feAv hours, at tlie end of tlie seveutli week of lier illness. Dr. A\ hituey, wlio uuide the i)OSt-uiortem exauii- nation, found the ])aiicreas of uoruial size and density, in general of an opacpie-gray color. .\t the lower ]):irt of the head was a trahcculated cavity with dirty-green, shreddy walls and contain- ing cheesy, necrotic, material. .\ large branch of the duct, with a ragged edge, ojamed directly into this cavity. Its wall, near the cavity, was green and soft. The main duct was intact, but con- tained, near its outlet, .a small <inantity of dirty- brown, vis<‘id fluid. 'Plu! j>ara])ancreatic fat-tissue formed a part of tlie wall of the cavity above men- tioned ; near tin* splenic mid of the jiancreas was a hole in the fat-tissue, as large as a walnut and containing a dirty-green fluid. Klsewhme in the neighboring fat-tissue, and in that of the mes- entery, meso-colon, and jiosterior abdominal wall were nnmerous o[iaque-white, ])ai>-like nodules from the size of a jiin-head to that of a pea. They were, at times, aggregated in clumps ; the contents coidil be squeezed out. The smallest nodules were fre- ([uently surmounted by an injected border. There wtis nothing abnormal in the jKirtal vein or its immediate radicles. The liver was in a con- dition of bniwn atrojihy, and there were minute, [lale-yellow calculi in the gall-bladder and common duct. There was no evidence of a general peritonitis, but on cutting through the meso-colon the stomach and colon were found slightly adherent. The mi- crosco]iic examination of the fat-tissue showed char- acteristic, necrotic patches Avith a margin of round- celled infiltration. Also occasional small abscesses and more diffused infiltrations of leucocytes. Ill addition, occasional, circumscribed, round spots were seen, composed, of more or less elongated and flat cells, enclosed within a fibrous border. The cells varied in size, some being considerably larger than fat-cells and containing several nuclei, Avhile the smallest had a diameter four times that of a red blood-corpuscle. These patclies suggested a$