505 



downward and forward (not horizontally forward as in Fig. 10) pushing 

 the empty intestines downward, and flattening the body of the pan- 

 creas backward against the suprarenal body behind. It seems certain, 

 therefore, that a distended stomach does flatten the pancreas 

 dorso-ventrally, and tends to obliterate the inferior surface, in the 

 outer half of the body of the pancreas^). 



The dorso-ventral flattening of the pancreas caused by the 

 distension of the stomach does not aflect the entire body of the 

 pancreas, but only the outer half, which lies behind the body of the 

 stomach. The inner half of the body of the pancreas, which is 

 related anteriorly to the pyloric portion of the stomach below, and to 

 the processus papillaris of the liver above (Fig. 6), is not subjected to 

 the same pressure (the pyloric portion of the stomach being capable 

 of only slight distension), so that the inferior surface of the pancreas 

 in this region is not diminished, and may even appear more pronounced 

 when the stomach is distended. 



The head of the pancreas, together with the pylorus and first 

 part of the duodenum, are aflected by distension of the stomach much 

 in the same way as ordinarily described for the adult, so no special 

 comment concerning these relations is necessary. 



Certain details in regard to the relation of the body of the 

 pancreas to the liver, the suprarenal body, and the splenic flexure of 

 the colon remain to be considered. The relation of the caudate pro- 

 cess of the liver to the head of the pancreas has already been dis- 

 cussed. As Erik Müller (11) has pointed out, the processus papil- 

 laris of the Spigelian lobe in the foetus projects downward and to the 

 left and also comes into contact with the pancreas behind the lesser 

 omentum and above the lesser curvature of the stomach. There is, 

 therefore, in the foetus no tuber omentale of the pancreas such as is 

 found in the adult, but instead, an impression or area papillaris, 

 the lesser omentum and left lobe of the Hver being for the most part 

 excluded from direct relation with the pancreas (cf. Figs. 1,2, 3, 4, 6 

 ap.). MÜLLER studied the relations in several foetuses from 20 cm 

 to 50 cm in length, and found that the area is quite variable in 



1) Contrary to the statement sometimes met in text-books, it is 

 quite probable that the same rule holds good for the adult pancreas. 

 It is true that in Luschka's ''Lage der Bauchorgane" (Tab. 4, Fig. 2) 

 and in Pikogoff's "Anatome topographica" (Fase. 3 A, Tab. 3) the body 

 of the pancreas appears distinctly triangular in sagittal section, but in 

 both cases the intestines as well as the stomach are seen to be 

 distended. 



