PANCEEATITIS. 415 



The peritoneal adhesions set up by inflammations of the gall 

 bladder may involve the duodenum, transverse colon or pylorus, 

 all of which are adjacent. Gastric pain and dilatation, or pain 

 in the region of the colon, may result. 



The part of the peritoneum first infected as the result of 

 inflammation or rupture of the gall bladder is the right kidney 

 pouch, which lies above the transverse meso-colon. The 

 omental stage of the common bile duct has been known to 

 rupture into the lesser sac, which is rendered possible by the 

 position of the duct in front of the foramen of Winslow. 



A stone lodged in the lower part of the ampulla of Vater may 

 ulcerate through the duodenal wall into the bowel, or cause a 

 retroperitoneal perforation. Barely it infects the peritoneum in 

 this region. Stones in this neighbourhood are in a position to 

 obstruct also the pancreatic duct or cause regurgitation of bile 

 into it. 



DISEASES OF THE PANCREAS. 



Inflammation of the pancreas, whether acute or chronic, is 

 usually a consequence of infection of the duct. The inflammation 

 may spread to it from the duodenum or from the bile duct in com- 

 mon with which the pancreatic duct usually opens. A gall stone 

 impacted at the lower end of the bile duct may impede the outflow 

 from the pancreatic duct and lead to infection, or if near the 

 orifice of the biliary papilla, may actually cause bile under 

 pressure to regurgitate into the pancreas and set up acute 

 inflammation in this way. On the other hand the swelling of 

 this gland when acutely inflamed may cause compression of the 

 common bile duct. Drainage of the bile ducts is sometimes 

 adopted as a means of indirectly draining the ducts of the 

 pancreas, but can only be effectual when both open into the 

 ampulla of Vater. 



It is probable that in some cases the pancreas is infected by the 

 blood stream. The only direct connexion between the parotid 

 gland, the pancreas and the testicle, is vascular, and all these 

 structures may be inflamed in mumps. It is possible that the virus 



