In the diagnosis of pancreatitis, much difficulty is invariably experienced. The obscure position of the organ is to blame for this.
Dr. Jayne reports two cases in the Annals of Surgery, of the disease in an acute form. The first case was thirty-three years of age, and had been in previous good health until two weeks before. She had had some slight intestinal indigestion, but on the morning of the attack she was feeling unusually well.
She was seized with sharp, smarting, agonizing pains in the epigastrium, which were followed by nausea, vomiting and collapse. The face was discolored, the pulse was 82, and the temperature 98° F. The tenderness and distension of the abdomen were greatly increased after a few hours, when the pulse rate increased to 120 and the temperature rose to 100° F.
After two and one-half days, preparations for an operation were made, when the patient expelled a large amount of ashy-gray, foul smelling feces, which contained neither fat nor undigested food. This gave so much relief that the operation was postponed, but the patient was exhausted and complained of pain in the epigastrium for several days.
The abdomen became soft and a mass the size of an orange could be felt in the region of the head of the pancreas. On the twenty-fifth day, after a severe chill which was followed by vomiting and a rise in temperature, an operation was decided upon.
A large quantity of grayish pus was evacuated from the pancreatic gland. A large drainage tube was introduced and the wound closed throughout the upper two-thirds. Pus drained freely for four days and at the end of the week pancreatic juice escaped through the opening and continued some days longer when the sinus closed. The second case with symptoms similar to those above described recovered without an operation.
Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.