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December 1955

Fatal Pancreatic Necrosis Following Choledochotomy and CholangiographyReport of a Case

Author Affiliations

From the Department of Surgery, University of Washington School of Medicine, and the Veterans Administration Hospital, Seattle.

AMA Arch Surg. 1955;71(6):885-889. doi:10.1001/archsurg.1955.01270180091012

Acute pancreatic necrosis is an uncommon but dreaded complication of surgery in the epigastric region. Those discussing its etiology agree only that the cause usually is a combination of factors. Experimentally, acute pancreatic necrosis may result from obstruction of the pancreatic ducts in the presence of a secreting or stimulated gland.* Nutritional factors may be important.† Although pancreatic necrosis in animals can be produced by the retrograde injection of bile along the pancreatic duct, it cannot be produced in this way experimentally unless the physiologic limit of biliary pressure (375 mm. bile) is exceeded.‡ In such cases, rupture of the smaller pancreatic ducts occurs and results in the release of pancreatic enzymes into the intercellular spaces.§ Rich and Duff,3 by injecting 3 to 10 cc. of India ink, showed that even small pressure excesses produced rupture of the smaller pancreatic ducts and extrusion of carbon particles into pancreatic tissue.

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