External Pancreatic Fistula: Report of a Case With Physiologic Observations

Conclusions

A case of external pancreatic fistula in which cure was effected surgically has been reported. Certain physiologic observations were made.

The fasting secretion of pancreatic juice through the external fistula, when the pancreatic juice was excluded from the duodenal cavity, was low in volume and in total bicarbonate and enzyme content.

The fasting secretion of pancreatic juice through the external fistula, when the gastric juice was allowed to enter the duodenal cavity, was variable but, for the most part was low in volume and bicarbonate content. The secretion of pancreatic juice through the external fistula, when gastric juice was excluded from the duodenum, was not measurably stimulated by glucose and casein and was only slightly stimulated by olive oil introduced through the duodenal tube into the duodenum.

Secretion of pancreatic juice through the external fistula was stimulated vigorously by glucose and casein administered orally. The effect of glucose and casein was similar to that obtained by administration of purified secretin. They effected an increase in volume and an increase in the total secretion of bicarbonate, amylase and lipase, just as purified secretin does. The secretion of pancreatic juice through the external fistula and its content of bicarbonate and lipase was not stimulated and was probably depressed by olive oil administered orally; the secretion of amylase, on the contrary, appeared to be mildly stimulated. The type of secretory response of volume of bicarbonate and of enzymes seemed to depend, first, on the gastric secretory response to food and emptying time of the stomach and, second, on the effect of gastric secretion on the secretin mechanism.