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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    of an acute ljunphaugitis, of abscesses, ami of throm- bosis. Ila^iteria were found in ami near the jiatclies of necrosis. They were likewise present in a neigh- boring vessel and in a venous thrombus. The association of these, appearances with the evidences of fat-necrosis indicate most directly that the latter condition, in fatal cases at least, instead of lieing simply the result of a hyjierplasia or of a degeneration, is connected with an jicute, intiammatory process, somewhat akin to the phh'gmonous inflammation of the subcutaneous fat. The cause of its dissemination would thus, prol>- ably, depend ujx)n the transfer of an infecting material, either through vascular currents, espe- cially lymjdiatics, or by direct inoculation of the peritoneum in case of the superflcial nodules. The inultijde disseminated fat-necrosis found associated with fatal pancreatic disease, is thus to l)e regarded as the result of the inflammation of the fat-tissue extended from the pancreas or its vicinity. The pancreas is usually the seat of the jirimary jirocess, but the necrotic inflammation of the fat-tissue may be secondary to a ]>ossible jirimary lesion of the biliary tract or stomach, as suggested by cases LVII. and LVIII. » The sj)ots of dead fat-tissue observed in the marantic cases may be degenerative as claimed by I’onfick and Chiari. They certainly are neither necessarily nor exclusively found in fat persons. There is no confirmatory evidence of their hyjier- plastic nature. The inflammatory fat-necroses, in most cases, were associated with evidences of putrefactive conditions. It would thus a])pear that there is a necrobiotic necrosis of the fat-tissue, and an inflammatory ne- crosis, the latter tending to become gangrenous, both of which may be found within or near the pancreas. The inflammatory and gangrenous vari- eties are of es])ecial importance in jiermitting the sloughing of the pancreas, and in most instances are the result of an acute inflammation of the gland.