The contents of a pancreatic abscess may be discharged in various directions. Some times they escape into the cavity of the ab domen; sometimes they pass into the stomach, and sometimes into the duplicature of the mesocolon, where they may' be retained as in a sac, or, having perforated one of its laminT, may be effused into the general cavity of the abdomen. It is supposed also that the pus of a pancreatic abscess may find its way into the intestinal canal, and be discharged by stool without any obvious communication being established between them. Thus, in a case communicated by Dr. Haygarth to Dr. Per cival, in which, on dissection after death, the pancreas was found to contain a considerable abscess, blood and, at length, fetid pus had been discharged by stool during life.
According to Dr. Pemberton*, ulceration is a very frequent result of inflammation of the pancreas ; and from the small degree of sensibility- with which the organ is endowed, the destruction may go a great way without pain or any symptom previously' existing which could lead to a suspicion that inflam mation was going on.
Portal alleges that gangrene of the pancreas is a frequent consequence of its inflammation, and that Ile has met with it in several in stances. In one case, which he particularly specifies, the pancreas was found, on examina tion, to be of a violet purple colour, softened, and allowing a blackish fetid humour to exude from its external surface. " In short," he says, " it was gangrenous almost throughout its whole extent." Gendrin quotes what he conceives to have been a case of gangrene of the pancreas, occurring after chronic inflam mation, and suggests it as probable that in this, as in other tissues, acute inflamma tion passes readily and completely into the state of' sphacelus, only in cases in which the organ has been weakened by previous disease.
c. Heemorrhage.—I have only met with two cases of hmmorrhage in the pancreas : one recorded by Mr. Fearnside, in which the right extremity was occupied by a large coagulurn ; the other related by Storck, in which the pancreas was so large and heavy that it ex ceeded thirteen pounds in weight. On cutting into this mass, it was found to consist merely of a sac filled with blood, partly grumous, partly coagulated, and beginning, it is stated, to become organised.
d. Structural changes. 1. Non-nzalignant; cartilaginous transformation.—MaDy cases are on record in which the pancreas had been found cartilaginous ; it is generally enlarged, nodular on the surface, and very- hard. In the majority of cases, one or more neighbouring organs have been found similarly affected ; but in some rare cases the pancreas has been the exclusive seat of the cartilaginous de generation. In persons affected with it nausea, vomiting, thirst, pain in the epi gastrium, &c., had existed, and it was pro bably' the remote consequence of chronic inflamination.
Steatonzatous concretions. —Portal states that the pancreas is sometimes found full of steatomatous concretions, hard or softened, white like suet, or yellowish like honey. Sometimes the pancreas is enlarged by this matter throughout its whole substance, some times it exists only in particular parts. Those who have died of scrofula, and in whom the glands of the neck, axillm, groins, or me sentery were obstructed, had likewise the pan creas equally affected. He mentions a par ticular case in which the mesenteric glands were full of steatomatous concretions, and in which the pancreas, besides being enor mously enlarged and full of similar concre tions, was covered by one of the consistence of suet and more than five or six lines in thickness. In this case the suriounding cel
lular texture, the rnesocolon, and the parietes of the stomach, were cartilaginous and thick ened, in consequence, he supposes, of the pressure of the tumour. He states, however, that the pancreas has been found affected when no marks of scrofula were observable in any other part of the body. Meckel states that he has seen the organ changed to an almost tophaceous mass.
The steatomatous concretion of Portal seems to be identical with the tztbercle of the present day ; and accordingly, both in the human subject and in the lower animals, tu bercles of the pancreas have been occasionally met with, particularly in cases in which the lungs had undergone a similar degeneration. M. Lombard states that of one hundred cases of tuberculous disease in children which he examined, he found, in five, tubercles exist ing in the pancreas.* Cystic tumours ; hydatids.— These are of rare occurrence. M. Becourt has described a preparation in the Museum of the Medical School at Strasburg, of a cyst of very large size in the body of the viscus. Dr. Gross has given the following description of one, in a communication to the Medical Society of Boston.1- On opening the body, a voluminous fluctuating tumour of oval form was found situated beneath the right lobe of the liver, with which it had contracted intimate ad hesions. It was placed between the intestines and the posterior abdominal wall, passed a little to the left of the vertebral column, and had in front of it the curvature of the duo denum. It contained from 10 to 14 ounces of a sero-sanguinolent fluid without clot, slightly viscid, and 'without any aprearance of fatty matter. There was not a trace in its walls of any of the normal tissue of the pancreas, although it as evidently formed by that organ. It contained some very small calculi, reseinbling those ordinarily met with in the ramifications of the pancreatic duct, and two of these, from three to four lines in dia meter and rough on their surface, completely obliterated the opening of the pancreatic canal into the duodenum ; they were composed of carbonate of lime. The rest of the pancreas — that is to say its left extremity— was about two inches long and very hard : the pancreatic canal of this portion of the gland opened into the cavity of the cyst. This circumstance, and the fact that that portion of the duct leading from the cyst to the duodenum was blocked up by the calculi, make it exceedingly probable that the cyst WaS primarily nothing but a dilatation of the duct in consequence of this obstruction. It is possible that this may be the origin of most of these cysts, and much to be regretted that the fluid contained in them has not been submitted to a rigorous examination, with the view of ascertaining whether it has any analogy to the secretion, or admixture with it. Two cases of reten tion of the pancreatic fluid recorded by Cru veilhier, confirm the probability of this sup position. " The dilated canal resembled a transparent cyst ; the contained fluid was extremely viscid and clear, but of a w hitish hue like a solution of gum arabic ; it had a slightly saline taste; the collateral ducts were extremely dilated. There were some white patches, resembling plaster, in the centre of many of the lobules. This substance was more abundant in some of the lobules, and, when removed, presented the appearance of small lumps of pla.ster or chalk." These creta ceous lumps might have been of the nature of pancreatic calculus, which we have already seen associated with a cyst involving the duct, or the earthy remains of old tubercle.