JULES BOECKEL (Strasburg) said that operations on the pan creas are indicated in traumatisms and inflammation with their sequelm (suppurative pancreatitis, gangrene, haemorrhage) in tumors both solid and cystic. Wounds of the pancreas are gen erally quickly fatal (haemorrhage and concomitant lesions of other organs). The treatment consists in asepsis and packing. Eight cases out of ten have died. Individual ligation of vessels injured is generally impossible on account of the patient's condition.
In inflammations and tumors the operation is sometimes done on the gland and sometimes in its neighborhood, e.g., a collection of pus may burrow away from the gland and be opened at a dis tance. When the affection is confined to the gland, operation is difficult and dangerous. The whole organ must not be removed, otherwise a rapidly fatal diabetes would result. Intrapancreatic operations are indicated in cases of tumor and localized pancrea titis. Three routes are available.
(a) The epigastric, when, as is rare, the tumor emerges above the lower curvature of the stomach.
(b) The gastrocolic route, the preferable operation.
(c) The transmesocolic, when the tumor has insinuated itself between the layers of the mesocolon.
Exceptionally, an incision in the flank is proper (tumors in the tail of the pancreas), and the operation becomes extraperito neal.