LIGATION OF THE TAIL OF THE PANCREAS IN JUVENILE DIABETES*

Abstract

The regenerative power of the pancreas has been established by numerous clinical observations. Of all structures the ducts and islets are most resistant to local destructive processes and seem to have the greatest growth potential. Various pathological conditions, such as luetic pancreatitis of the newborn, acute pancreas necrosis and carcinoma of the pancreas destroy a great deal of pancreatic tissue. External secretion may suffer or completely subside in some of these conditions, as for instance in a carcinoma of the head of the pancreas, with compression of the duct. Whether the insular activity is insufficient or not will depend on the rapidity with which pancreatic destruction takes place. Thus in acute pancreas necrosis, high blood sugars and abnormal sugar tolerance curves are almost a rule, and glycosuria not uncommon. Gradually, however, sugar tolerance returns to normal (Jorns, 1; Sebening, 2). In Sebening's series all cases of acute pancreas necrosis showed a normal sugar tolerance at the end of six months. Sprengell (3) saw the hemorrhagic pancreas necrosis at operation and removed a large sequestrum of pancreatic tissue. When ten months later the patient died of an acute intestinal obstruction, only a slight fibrosis in the body of the pancreas indicated the residue of previous destruction. The patient was sugar free. Histologically there were numerous and very large islands. Knopfloch (4) reported the autopsy of an eighty-two-year-old patient, who had had an acute pancreas necrosis forty years before. There was a marked atrophy and lipomatosis of the organ, which could be explained by the findings of concrements in the ducts which obstructed external secretion. In the lipomatous organ, intact, well preserved islands were numerous. There was no glycosuria.