THE PANCREAS. 



423 



cm. (5 in. ) long and runs transversely from the first portion of the duodenum across 

 to the spleen. The flexure joining the head and body constitutes the neck. It is 

 2.5 cm. (i in.) long. The tail is simply the extremity of the body ; this is omitted 

 in some descriptions. The body crosses the first lumbar vertebra, while the head 

 lies on the right side of the second and third (Fig. 432). 



Pancreatic Ducts. The pancreas has two ducts, a main one called the pan- 

 creatic duct, or duct of Wirsiing, and an accessory one called the diict of Santorini. 

 The duct of Wirsung runs nearly the whole length of the gland, and, bending some- 

 what downward at the neck and joining the common bile-duct at the ampulla of 

 Vater, pierces the duodenum obliquely and empties in a common orifice on its 

 mucous surface. It is 3 to 4 mm. (^ to ^ in. ) in diameter at its termination. The 

 accessory duct of Santorini comes mainly from the lower portion of the head of the 

 pancreas and empties separately in the duodenum 2 cm. ( ^ in. ) above and a little 

 anterior to the biliary papilla. It communicates with the duct of Wirsung in the 

 substance of the pancreas. 



Relations. Posteriorly, the head lies on the vena cava while the body crosses 

 the aorta, renal vessels, suprarenal gland, and left kidney. Anteriorly, it is covered 

 with peritoneum and on it lies the stomach ; inferiorly, is the attachment of the trans- 



Portal vein 



Gall-bladder 

 Hepatic duct- 



Cystic duct-*:.. 



Common bile-duct 



Second portion 

 of duodenum 



Hepatic flexure 

 of colon 



FIG. 432. The pancreas and spleen. 



Hepatic artery 



Cceliac axis 

 Gastric artery 



Gastroduodenal 

 artery 



Spleen 

 Splenic artery 



Descending colon 



Superior mesenteric 

 vessels 



verse mesocolon, beneath which comes the duodenojejunal flexure. Immediately to 

 the right of this flexure and between it and the head of the pancreas issue the superior 

 mesenteric vessels. At the extreme left is the splenic flexure of the colon. 



Pancreatic Cyst and Abscesses. The pancreas is the subject of inflam- 

 mation (hemorrhagic) which may cause necrosis and abscess; it also is affected with 

 cysts and new growths. Calculus may also occur. 



Suppuration may produce a sub-diaphragmatic abscess or perforate the dia- 

 phragm and form an empyema. In cases of abscess protruding anteriorly, instead 

 of opening through the peritoneum in front, the pus may be evacuated through a 

 posterior incision made in the right or left costovertebral angle. If the pus has been 

 evacuated through an anterior incision the finger may be introduced into the abscess 

 cavity and used as a guide for a posterior incision. 



Pancreatic growths tend to project forward in one of three general directions 

 viz. : (i) between the liver above and the stomach below; (2) between the stomach 

 above and the transverse colon below; (3) below the transverse colon. The second 

 is the most frequent. When the enlargement comes forward opposite the attach- 

 ment of the transverse mesocolon it may grow between the layers of the mesocolon 

 and push the transverse colon in front of it instead of going below or above it. After 

 the cyst has been evacuated it may be stitched to the edges of the incision anteriorly 

 and a counter opening made posteriorly on the left side beneath the twelfth rib. 



