THE PANCREAS. 



945 



padded forceps. If this does not succeed, the safest plan is to incise the duct, extract the stone, 

 and close the incision by fine sutures in two layers. After all obstruction has been removed, 

 four courses are open to the surgeon : 1. The wound in the gall-bladder may be at once sewn 

 up, the organ returned into the abdominal cavity, and the external incision closed. 2. The 

 edges of the incision in the gall-bladder may be sutured to the external wound, and a fistulous 

 communication established between the gall-bladder and the exterior ; this fistulous opening 

 usually closes in the course of a few weeks. 3. The gall-bladder may be connected with the 

 intestinal canal, preferably the duodenum, by means of a lateral anastomosis; this is known as 

 cholecystenterostomy. 4. The gall-bladder may be completely removed. 



THE PANCREAS. 



Dissection. The pancreas maybe exposed for dissection in three different ways : 1. By 

 raising the liver, drawing down the stomach, and tearing through the gastro-hepatic omentum 

 and the ascending layer of the transverse mesocolon. 2. By raising the stomach, the arch of 

 the colon, and great omentum, and then dividing the inferior layer of the transverse mesocolon 

 and raising its ascending layer. 3. By dividing the two layers of peritoneum, which descend 

 from the great curvature of the stomach to form the great omentum ; turning the stomach 

 upward, and then cutting through the ascending layer of the transverse mesocolon (see Fig. 488, 

 page 900). 



The Pancreas (Ttav-xpsaz, all flesh} is a compound racemose gland, analogous in 

 its structure to the salivary glands, though softer and less compactly arranged than 

 those organs. It is long and irregularly prismatic in shape, and has been compared 

 to a human or a dog's tongue : its right extremity being broad, is called the head 

 this is connected to the main portion of the organ, the body, by a slight constriction, 

 the neck ; while its left extremity gradually tapers to form the tail. It is situated 



FIG. 519. The pancreas and its rc'ations. 



transversely across the posterior wall of the abdomen, at the back of the epigastric 

 and left hypochondriac regions. Its length varies from five to six inches, its 

 breadth is an inch and a half, and its thickness from half an inch to an inch, being 

 greater at its right extremity and along its upper border. Its weight varies from 

 two to three and a half ounces, but it may reach six ounces. 



4 The right extremity or head of the pancreas (Fig. 519) is shaped like the head 



of a hammer, being elongated both above and below ; it is flattened from before 



backward, and conforms to the whole concavity of the duodenum, which is slightly 



overlapped by it. The anterior surface near its left border is crossed by the 



60 



