354 



Scientific Proceedings (123). 



duodenum in man in order to determine the percentage of in- 

 stances in which there would be an anatomic basis for the fore- 

 going hypothesis. Our data conclusively prove that the number 

 of instances in which the anatomic arrangement in the relation- 

 ship of the two ducts would permit bile to pass into the pancreatic 

 duct is very small. The other possibility that the sphincter at 

 the duodenal end of the common bile duct could contract and 

 convert the two ducts into a continuous channel has been investi- 

 gated. Our data show that in most instances in man the sphinc- 

 ter is located at a point where contraction will close both ducts 

 and will not convert them into a continuous channel. In a very 

 small percentage of instances a small bundle of muscle fibers is 

 found in a position where possibly it could convert the two ducts 

 into a continuous channel. While there is an anatomic basis for 

 the possibility of converting the two ducts into a continuous 

 channel, either by mechanical obstruction or possibly by the ac- 

 tion of a sphincter muscle, the percentage of instances in which 

 this could occur is very small. 



Experimentally we followed three lines of investigation: (1) 

 to estimate the possible pressure the existing physiologic mechan- 

 ism could exert to inject bile into the pancreatic duct; this pressure 

 we have found to be relatively low; (2) to inject sterile bile into 

 the pancreatic duct at the maximal pressure that could occur in 

 the common bile duct; this did not produce typical hemorrhagic 

 pancreatitis, although definite damage of the pancreas sometimes 

 occurred; and (3) to ligate the common bile duct in goats (a 

 species in which the main pancreatic duct opens into the common 

 bile duct) ; this does not produce acute pancreatitis. 



Our investigation has proved that an anatomic and physio- 

 logic basis for the theory that reflux of bile may occur in the pan- 

 creatic duct does exist. The evidence indicates that such a reflux 

 of bile may rarely be the cause of chronic pancreatitis. The num- 

 ber of instances in which the necessary anatomic conditions are 

 present for such an occurrence is very small. The possibility of 

 bringing into play a physiologic mechanism which can infiltrate 

 the pancreas with sterile bile to an extent actually to produce 

 acute pancreatitis is questionable. Granted that the necessary 

 anatomic, physiologic and pathologic factors are present and that 



