Transection of the pancreas by blunt trauma.

If a diagnosis of traumatic pancreatitis is made and the patient does not improve clinically during the first 24 hours, transection of the pancreas should be suspected. If this is found to be the case at operation, the distal pancreas should be resected and the proximal end of the pancreas closed carefully with interrupted mattress suture of non-absorbable suture material. Particularly, the pancreatic duct should be ligated to prevent the formation of an external fistula.

Splenectomy in blood dyscrasia.

THE DECISION FOR SPLENECTOMY MUST BE BASED ON A KNOWLEDGE OF THE THREE FUNCTIONS OF THE SPLEEN: Hematopoiesis (usually ceasing during fetal life but sometimes resuming when bone marrow function fails); filtration of abnormal and senescent cells and control of bone marrow activity, most probably humoral. When bone marrow function fails, splenectomy is contraindicated since splenic hematopoiesis becomes a vital function. On the other hand, when a large proportion of erythrocytes are abnormally shaped (spherocytes), although otherwise adequate, the spleen may trap these cells in its filter and destroy large numbers.

Sliding indirect inguinal hernia.

From 2 per cent to 5 per cent of all indirect inguinal hernias are of the sliding variety. (Sliding hernias are those in which part of the wall of the sac is formed by a viscus.) The proportion of sliding hernias is even higher in the aged.