418 CLINICAL APPLIED ANATOMY. 



the liver and the stomach ; or it may push the stomach 

 forwards or present below it, above the transverse colon. 

 Following the connective tissue planes it may insinuate itself 

 between the layers of the transverse mesocolon and, reaching the 

 lumbar region, surround the kidneys. The duodenum, colon and 

 stomach are the parts of the intestinal tract into which a pan- 

 creatic abscess is most likely to perforate, particularly the two 

 latter on account of their close relationship to the head of the 

 gland. 



Pancreatic cysts may arise when the main duct is obstructed 

 by a pancreatic calculus, or by a gall stone in the ampulla of 

 Vater, or by external pressure. The relations of the pancreas to 

 the peritoneum have considerable influence in determining the 

 directions in which cysts may extend and present themselves. The 

 greater part of the head and body of the gland is in immediate 

 relation with the lesser sac. Consequently pancreatic cysts 

 usually project into the lesser sac, either pushing the stomach 

 in front of them or presenting above, between it and the liver, 

 or below, between it and the transverse colon. But pancreatic 

 cysts may project into the greater sac ; thus a cyst arising to 

 the right of the foramen of Winslow may bulge in the right 

 hypochondrium, simulating a cyst of the kidney or suprarenal 

 body or a distended gall bladder. A cyst springing from the 

 head of the gland below the transverse mesocolon may present 

 below the hepatic flexure of the colon and be mistaken 

 for a renal or colic tumour ; the root of the mesentery will 

 prevent such a cyst from encroaching on the left half of the 

 abdomen. It is possible for a cyst arising from the uncinate 

 process of the gland to appear to the left of the root of the 

 mesentery, below the transverse colon, where it may simulate a 

 tumour of the left kidney, or one arising from the colon in this 

 situation or from the small intestine. If large it may even simu- 

 late an ovarian cyst. Cysts in some cases burrow between the 

 layers of the mesentery or of the transverse colon when they 

 spring from the gland opposite the point of reflection of the peri- 

 toneum to form these folds. When cysts arise from the posterior 



