Hunterian lectures on the pathology and surgery of certain diseases of the pancreas : delivered before the Royal College of Surgeons of England on March 7th, 9th, and 11th, 1904 / by A.W. Mayo Robson.

  • Robson, Arthur William Mayo, Sir, 1853-1933.
Date:
[1904]
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Licence: In copyright

Credit: Hunterian lectures on the pathology and surgery of certain diseases of the pancreas : delivered before the Royal College of Surgeons of England on March 7th, 9th, and 11th, 1904 / by A.W. Mayo Robson. 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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    being completely surrounded in that situation by pancreatic tissue. Two processes of the pancreas passed from the upper part of the head of the gland towards the right, one in front and the other behind the duodenum. They blended on its outer side so as to form with the head of the gland a ring of pancreas encircling the duodenum. The processes became somewhat narrower as they passed outwards and the portion of the gland on the right side of the duodenum was about half an inch in vertical extent. On dissecting out the ducts of the pancreas nothing unusual was observed in their arrangement. The common bile-duct opened into the duodenum below the seat of the constriction. The cir- cumference of the distended duodenum where it was surrounded by the pancreas was two and a half inches, while above and below that it was more than three times as large.” The intimate relation of the head of the pancreas to the duodenum may lead to invasion of the intestine by disease of the gland as I have seen on several occasions and as can be seen in the specimen from St. George’s Hospital Museum, 201a, a photograph of which is now thrown on the screen, or to the converse ‘ ‘ invasion of the pancreas from cancer of the duodenum,” an example of which was lately shown me by Dr. J. F. H. Broadbent, pathologist to St. Mary’s Hos- pital. The duodenum may also be compressed or distorted by a cyst or other tumour of the pancreas or by a pancreatic abscess which may burst into it and so be discharged, as in a case that came under my own observation. In the Annals of Surgery for August, 1899, a case is reported by Gallandet in which a cancer of the head of the pancreas so far obliterated the lumen of the duodenum as to call for gastro enterostomy. The proximity of the pancreas to the stomach renders it liable to invasion by ulcer or cancer of that organ (Fig. 1) and it is well recognised by surgeons how adhesion to, or invasion of, the pancreas by a cancerous growth of the stomach or pylorus not only adds seriously to the danger of operation but renders a return of the disease extremely probable if removal be attempted. Von Mikulicz’s experience is most instructive; of 91 partial gastrectomies without injury to the pancreas the mor- tality was 27 5 per cent., but in 30 cases of gastrectomy in which the pancreas was injured or partly removed it was 70 per cent. Nevertheless', as part of the operation of gastrectomy, a partial pancreatectomy has been successfully performed on several occasions by Mikulicz, Kocher, and others. In an analysis of 100 cases of cancer of the pylorus Fenwick found the pancreas adherent in six. In 100 cases of cancer of the cardiac end of the stomach the pancreas was adherent on 16 occasions, and in a similar number of cases of cancer of the lesser curvature or posterior wall it was adherent in 19. I have found ulcer invading the pancreas from the stomach, pylorus, or duodenum on several occasions, and in such cases I have as a rule deliberately