194 



PANCREATIC FISTULA. 



[BOOK ii. 



Method of 

 Ludwig, em- 

 ployed by his 

 pupils Wein- 

 mann x and 

 Bernstein 2 . 



' Preference is given to small dogs, as in them the 

 duodenum is more easily reached from the middle line, 

 and is not drawn so far from its natural position by the 

 fistula as in larger animals. The dog must be kept fasting 

 on the day of the operation, as the pancreatic vessels are 

 full during digestion, and bleed easily. Narcotize the 

 animal by injecting opium into the tibial vein, and open the abdomen 

 by an incision about two centimetres long in the linea alba, midway be- 

 tween the ensiform cartilage and the umbilicus. The duodenum is then 

 searched for, and drawn out of the wound along with the attached pan- 

 creas, and a thread looped round the duct. Instead of then putting in 

 a cannula, a piece of lead wire is inserted into the duct, so that one end 

 of it passes into the intestine and the other into the gland to a consider- 

 able distance. The middle part of it is twisted together, and projects 

 through the wound. Owing to the T shape thus given to the wire, it 

 cannot either slip out or move about in the duct ; but wire being chosen 

 which does not fill it up, the flow of the juice is not hindered. Three 

 threads having then been passed through the wall of the duodenum near 

 the duct, the intestine and omentum are replaced in the abdomen, and the 

 duodenum fastened by the threads to the abdominal wall. The wound is 

 then sewed up, care being taken that the twisted part of the lead wire 

 passes through the wound. Twenty-four hours after the operation, the 

 stitches are taken out, but the wire left in. In two or three days after- 

 wards the juice is collected. For this purpose the animal must be sup- 

 ported by straps, which pass under its belly, and are attached to a 

 horizontal bar hung from the roof by a cord and pulley. The dog is 

 then suspended over a table at such a height that it can barely touch 

 it with its toes, in which position it remains perfectly still. A funnel 

 is then attached under the fistula, and the juice collected in a glass 

 below 3 .' 



Heidenhain 4 has suggested another method which has 

 Heidenhain for ena ^^ e( i hi m * obtain much more trustworthy results than 

 establishing are furnished by fistulae established in any of the ways 

 permanent previously described. 



The portion of duodenum into which the duct of 

 Wirsung opens is separated from the rest of the intestine 

 by two sections, which are at a distance one from the other of 4 5 

 centimetres. The continuity of the alimentary canal is re-established as 

 in Thiry's operation by sutures. The isolated cylinder of duodenum is 

 slit longitudinally opposite the entrance of the pancreatic duct, and its 

 mesenteric surface is stitched to the abdominal wall ; the wound in the 

 abdominal wall is then brought together. The mucous membrane of 

 the intestine with the papilla of exit of the pancreatic duct is thus 

 brought to the surface of the abdomen, and the secretion may be directly 

 collected. 



1 Ludwig u. Weinmann, Ztsch. f. rat. Med. N. F. Bd. m. (1853) S. 248. 



2 Ludwig u. Bernstein, Ber. d. sacks. Gesell. d. Wiss. Math. phys. Cl. 1869, S. 97. 



3 Dr Lauder Brunton, F.E.S., in Handbook for Physiological Laboratory, p. 518. 



4 Heidenhain, Physiologic d. Absonderungsvorgange. 4. Abschn. Bauchspeichel- 

 driise. Hermann's Handbtich, Bd. i. Th. 1, S. 179. 



