. Manual of operative surgery. ologists, internists, and surgeons, more knowledge has been attainedand this hermit kingdom is being opened up to surgical therapy. The pancreas reaches from the duodenum to the spleen and discharges itssecretions through the canal of Wirsung into the duodenum. Before entering PANCREATIC CYST 537 the gut the canal of Wirsung unites with the common bile-duct to form thediverticulum or ampulla of Vater (Fig. 672). Besides the main duct or canalof Wirsung, there is a secondary duct (duct of Santorini), which arises from themain duct near the head of the gland and di
. Manual of operative surgery. ologists, internists, and surgeons, more knowledge has been attainedand this hermit kingdom is being opened up to surgical therapy. The pancreas reaches from the duodenum to the spleen and discharges itssecretions through the canal of Wirsung into the duodenum. Before entering PANCREATIC CYST 537 the gut the canal of Wirsung unites with the common bile-duct to form thediverticulum or ampulla of Vater (Fig. 672). Besides the main duct or canalof Wirsung, there is a secondary duct (duct of Santorini), which arises from themain duct near the head of the gland and discharges into the duodenum at aslightly higher level. The tail or left extremity of the pancreas lies in front ofthe left kidney and the suprarenal capsule. The most important vascularrelations of the pancreas are the splenic artery on its upper surface, while at itshead is the pancreatico-duodenal artery, which forms an arch with the superiormesenteric. The pancreas lies behind the posterior parietal peritoneum and in WJM.,0,. TfMutMrae CoIm Fig. 672.—Anatomical relations of the pancreas. {Mayo.) front of the lower portion of its head is the transverse mesocolon; in front of itsbody is the stomach. There are several routes by which the pancreas may be reached: (i) Throughthe gastro-hepatic omentum above the stomach; (2) through the gastro-colicomentum below the stomach; (3) through the transverse mesocolon back ofcolon and the stomach; (4) by retracting inwards the second part of the duo-denum; (5) through the stomach; (6) from the loin behind the peritoneum. Operation upon a pancreatic cyst forms a good type on which to base adescription of surgical interference. Step I.—Open the abdomen in or near the middle line above the the cyst makes a prominent swelling, it may be well to make the incision,vertically, over its most prominent part. Explore the abdomen, note the pres-ence and extent of adhesions, and where the cyst presents. This may beabove, behind or be
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