Abstract
During a recent study of the reaction of the peritoneum to sterile bile, fat necrosis was frequently observed in the mesentery near the pancreas. The term fat necrosis has come to mean a special form of necrosis characterized by the hydrolysis of neutral fat into fatty acids and glycerol, the former combining with calcium to form insoluble soaps.
In a series of 20 dogs after ligating the common bile duct and making a stoma in the gall bladder, bile was allowed to drain into the peritoneal cavity. Eighteen hours later the peritoneal cavity presented the picture of an acute severe general peritonitis and contained several hundred cubic centimeters of a serosanguinous exudate in which were observed polymorphonuclear leukocytes and B. welchii. Areas of fat necrosis 1 cm. in diameter were present in the fat of the mesentery adjacent to the pancreas in 15 out of 20 dogs in this series. The pancreas of these animals when examined both grossly and microscopically was normal.
The effect of an intraperitoneal injection of 2.5 cc. of a 10% solution of bile salts was then studied in a series of 20 dogs, and extensive areas of fat necrosis were observed in all instances. A peritonitis identical with bile peritonitis was produced and fat necrosis was observed in the fat near the pancreas, in the omentum, mesentery and the retroperitoneal fat. Gross and microscopic examination of the pancreas failed to find any evidence of necrosis, distension of the ducts or an inflammatory exudate.
Inasmuch as B. welchii was cultured from the peritoneal exudates of the peritonitis produced by both bile and bile salts, the effect of an intraperitoneal injection of cultures of this organism was studied. When 20 cc. of an 18-hour broth culture of B. welchii was administered, a peritonitis identical with bile peritonitis was produced; however no fat necrosis was observed.
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