THE PANCREAS 1343 



and the fluid of this pseudocyst may contain pancreatic juice (Jordan Lloyd). True cysis of 

 the pancreas are occasionally found. Pancreatic cysts may result from blocking of the duct, 

 from epithelial proliferation, from traumatism and hemorrhage, or from hydatid disease. Con- 

 genital cysts may occur, and cystic carcinoma is sometimes encountered. Cysts of the pancreas 

 may present in the epigastric region above and to the right of the umbilicus. The fluid in these 

 cysts contains some of the pancreatic secretion. A pancreatic cyst is best treated by opening 

 the abdomen, suturing the cyst to the skin, opening the cyst, and providing for drainage. Com- 

 plete extirpation of the cyst is invariably difficult and is usually impossible. It has been said 

 that the pancreas is the only abdominal viscus which has never been found in a hernial protru- 

 sion ; but even this organ has been found, in company with other viscera, in rare cases of dia- 

 phragmatic hernia. The pancreas has been known to become invaginated into the intestines 

 and portions of the organ have sloughed off. In cases of excision of the pylorus great care must 

 be exercised to avoid wounding the pancreas, as the escape of the pancreatic fluid may be attended 

 with serious and even with ratal results, peritonitis and fat necrosis, and gangrene being caused. 



Rupture of the pancreas as a solitary result of traumatism is very unusual, but is more common 

 in violent injuries which rupture the liver and spleen as well. An injury which lacerates the 

 pancreas and permits blood and pancreatic juice to flow into the lesser peritoneal cavity is usually 

 rapidly fatal, but may not be. The foramen of Winslow may be occluded by inflammation, and 

 a pseudocyst may form. In severe laceration of the pancreas alone it would be proper to open 

 the abdomen, ligate bleeding vessels, suture the pancreas, and drain the lesser peritoneal cavity 

 posteriorly. A gunshot wound of the pancreas requires posterior drainage. Every effort must 

 be made in a pancreatic wound to rapidly get rid of pancreatic fluid by drainage from the wound 

 area, as this fluid is extremely irritant and may cause gangrene. 



Inflammation of the pancreas is due to infection. Occasionally it seems to follow the entrance 

 of bile into the pancreatic duct, because of plugging of the ampulla with a calculus (Halsted, 

 Opie). Hemorrhage into the pancreas is frequent in acute pancreatitis, and fat necrosis is com- 

 mon in the fat of the mesentery, subperitoneal tissue, omentum, and other parts. Acute pan- 

 creatitis may be recovered from if the abdomen is opened, the pancreas incised, and drainage 

 employed. 



In chronic interstitial pancreatitis of the head of the pancreas the bile duct is apt to become 

 blocked, and the disease is frequently mistaken for cancer. Cure may follow opening and 

 drainage of the gall-bladder. 



Extensive fibrosis of the islands of Langerhans is one of the commonest lesions found post 

 mortem in cases of diabetes mellitus. 



