A New Type of Pancreatic Fistula ∗

Abstract

Several types of pancreatic fistulae have been devised for the study of the external secretion of the pancreas since DeGraaf first tied a cannula in the sectioned pancreatic duct of the dog and led it through the skin. This method and in particular the modification introduced by Elman and McCaughan 1 serves very well for acute experiments. The cannula however usually loosens and comes out after 10 to 15 days and the fistula closes or the animal dies. The method of Heidenhain 2 and Pawlow, 3 whereby the piece of duodenal wall containing the entrance of the lower pancreatic duct in the case of the dog is transplanted into the skin of the abdominal wall is more useful for chronic experiments. This has, however, the limitation in that relatively small amounts of secretion are obtained (200 to 300 cc. per day), the excoriation of the skin is very troublesome, the secretion is contaminated by contact with the abdominal wall, and lastly an ascending infection of the pancreas often results via the ducts and the secretion stops almost completely. In an attempt to obviate some of these difficulties the following type of pancreatic fistula was devised.

The duodenum was cut across 2 cm. distal to the pylorus and again about 8 cm. lower down, just below the entrance of the lower pancreatic duct. The pyloric antrum was resected and the lower duodenum anastomosed to the open end of the stomach by the end to side suture. The common bile duct was sectioned near its entrance into the duodenum and implanted either into the stomach or upper jejunum. The upper short section of duodenum containing the entrance of the pancreatic ducts (usually 2 or more in the dog) was converted into a closed sac by inversion and closure of both ends.