The cause of fat necrosis following excision of the pancreatic duct from the duodenum

Abstract

Excision of the pancreatic duct from the duodenum, together with a piece of duodenum attached to it, and leaving this structure freely open in the abdomen, leads to fat necrosis. The fat necrosis is not due to activation of pancreatic enzymes in the abdomen, but it is due to the successful prevention of the formation of adhesions between omentum or bowel and the flap of duodenal mucosa attached to the duct. The reasons for the prevention of the formation of adhesions are the secretion of mucus and of enteric fluid by the flap of duodenal mucosa and the formation of a cap of mucosa over the contracted piece of duodenal muscle. The latter covers the edges of the duodenal musculature and thus covers a traumatized area, which otherwise would predispose to formation of adhesions. Experiments in which the pancreatic duct with the attached piece of duodenal mucosa was traumatized in such a way as to produce conditions favoring formation of adhesion, proved this point.