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Article
February 2, 1929

TREATMENT OF DUODENAL AND FECAL FISTULAFURTHER OBSERVATIONS

Author Affiliations

ST. JOSEPH, MO.

JAMA. 1929;92(5):359-363. doi:10.1001/jama.1929.02700310005002
Abstract

Since the first publication of my1 observations on the treatment of duodenal fistula, further experience has furnished additional data and proof that the pancreatic juice plays the major rôle in the resistance to healing of duodenal fistulas, most fecal fistulas of the small intestine, and many of the large intestine, when there is a liquid or semiliquid content on account of an excess of pancreatic juice. By controlling the proteolytic action of trypsin, the very powerful enzyme contained in the pancreatic juice, one has the means of stopping the extensive irritation and digestion of the abdominal wall, which is fairly eaten up if it is allowed to continue unchecked for even a short period of time. As was previously stated, the main action of the pancreatic juice is the digestion of protein in an alkaline medium, which is the normal reaction of the contents of the duodenum and small

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