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.

    6/16 (page 6)
    varying in size from minute, almost imperceptible spots to others one-sixth of an inch in diameter, some a dead white, some a golden yellow, others a greyish yellow, and some a milky white, were seen throughout the peritoneal cavity wherever fat was situated. The peritoneal cavity contained a good deal of blood-stained fluid. There was no peritonitis. In the position of the pancreas a large hard mass about three or four times as large as a normal pancreas was found, which appeared to be chiefly made up of blood of a dark chocolate colour. On section very little trace of any normal-looking pancreatic tissue could be seen; the whole organ was infiltrated with, and appeared to be tightly distended with, blood. In places dark-brownish breaking-down necrotic areas were seen, the largest being about a quarter of an inch in diameter. The inter-acinous, inter-lobular, and peri- pancreatic tissues all appeared to be infiltrated with blood. The head of the pancreas appeared to be the most thickened part of that organ ; it measured 42 centimetres in the antero- posterior diameter. The gall-bladder was thickened; it contained several gall-stones and a thick brownish fluid. The liver weighed 60 ounces and it was normal. The spleen also was normal; it weighed four and a half ounces. An examination of the pancreas and its adjacent tissues some time after it had been lying in formalin solution showed some reddish areas of hmmorrhage in the fat of the mesentery similar in size and form to the areas of fat necrosis and suggested that the earliest change which took place in the fat was one of haemorrhage. The kidneys were normal; they weighed 10 ounces. There was a considerable amount of haemorrhage into the perinephric tissues and in the fat numerous points of fat necrosis were seen. On microscopical examination sections of the pancreas showed marked inflammatory changes. The outlines of the acini were just visible; the nuclei of the cells lining the acini were, however, unstained and were almost indis- tinguishable from the protoplasm of the cells which was granular and cloudy in appearance. In places no traces whatever of the normal pancreatic structure could be seen, it being replaced by a structureless granular debris. No marked blood extravasations were visible ; the blood-vessels generally were very distended with blood. The fat in the interlobular tissue showed many areas of fat necrosis. The increase in the size of the pancreas was more apparent than real, as the blood was almost entirely efiused into the peri- pancreatic tissues. The mediastinal and pericardial fat showed typical fat necrosis.