Two cases of acute haemorrhagic pancreatitis / by J.H. Bryant.

  • Bryant, John Henry.
Date:
[1900]
Catalogue details

Licence: In copyright

Credit: Two cases of acute haemorrhagic pancreatitis / by J.H. Bryant. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    he became very collapsed and he died at 5.30 p.m. The cause of death was considered to be peritonitis and the primary condition was thought to be rupture of the common bile duct or of one of the hepatic ducts. The fluid obtained at the operation contained a large quantity of bile. Cultures were taken and proved to be sterile both under aerobic and anaerobic conditions. No micro-organisms could be detected on microscopical examination of the fluid. The necropsy was made 20 hours after death when rigor mortis was well marked. The body was anaemic but it was not wasted. The conjunctive were slightly tinged with yellow. The brain was not examined. There was no pleurisy but there were numerous sub-pleural petechias. The lungs were normal. The heart weighed nine ounces and was normal. General acute peritonitis was found, the perito- neum being injected and covered with flakes of yellow bile- stained lymph. At the time of the operation there was no peritonitis, so that it must have followed the draining of the peritoneal cavity. The coils of intestine were found adher- ing to each other. There was a good deal of turbid bile- stained fluid in the peritoneal cavity. The peritoneal blood- vessels were much congested. The stomach and duodenum were quite normal ; there was no ulceration or perforation and the mucous membrane presented quite a healthy appear- ance. The small and large intestines were also quite normal in appearance. The pancreas was much enlarged, feeling about one and a half times as large as it should have been under normal conditions. It was adherent to the adjacent structures and it was covered with lymph which was deeply stained with bile. The under-surface of the liver was covered with lymph and the connective tissue in the portal fissure had a sodden appearance and was deeply stained with bile. Bile could be squeezed from the gall-bladder into the duodenum. The gall-bladder was not abnormally large, but its walls were oedematous. The common duct was patent and its mucous membrane was bile-stained; it was not ulcerated and there was no fistulous opening. The hepatic ducts were normal, so also was the cystic duct. A small calculus of about the size of a pea was found in the common duct resting in a fold of mucous membrane just where the cystic duct joined it. The fat in the neighbour- hood of the pancreas showed spots and patches of fat necrosis. The pancreas was firm and hard. There were many little infiltrations of blood either into the tissues of the pancreas or into the adjacent tissues. The parenchyma had