The article presents data on the development in the lumen of the pancreatic duct of condensed protein masses in people who died from the development of severe acute pancreatitis. 10 pancreas (areas of the head, body and tail, ductal system of the pancreas) of people who died of acute pancreatitis were subjected to histological examination. The material was fixed in 10% formalin solution, carried out in alcohols of increasing strength and enclosed in celloidin. The sections were stained with hematoxylin and eosin. A histological examination revealed that the condensed masses were represented by heterogeneous protein formations, cells of desquamated ductal epithelium, blood elements, fibrin threads. They completely filled the lumen of the pancreatic ducts and stopped the movement of pancreatic secretion. The data on the treatment of severe pancreatitis in experimental studies using the method of bougie and washing the pancreatic ducts with a novocaine-contrical mixture are presented. Two methods are proposed for restoring the permeability of the pancreatic duct in pancreatic necrosis in humans. Possible ways of the formation of fistulas and cysts are suggested, as a complication in the severe course of acute pancreatitis.

The presence of many hypotheses of the development of acute pancreatitis such as pancreatic duct hypertension, pancreatic reflux, vascular, allergic, neuro-reflex, infectious, etc. confirm the lack of a clear understanding of the development mechanisms of this pathology, and hence inaccuracy in the treatment and negative consequences. The purpose of this study was to investigate the effect of bouginage and flushing of the pancreatic duct on the course of experimental acute pancreatitis. Experiments were carried out on 12 dogs, for which a model of pancreatitis was created by autobile administration into the pancreas duct. Animals were divided into four groups, 3 animals per each, with the term of deduce from the test in one, three, seven days and six months respectively. Before the pancreas duct perfusion, it was injected with polyvinylchloride bougie that was removed through the incision in the distal part of the pancreas duct. Such manipulation allowed to conduct duct washing with medicinal substances at a pressure of 0.49-0.6 kPa and confirmed the assumption that in acute pancreatitis, filling of pancreas duct with condensed protein masses was observed, and this, changes the approach not only to the establishment of the pathogenetic link in the process of acute pancreatitis development, but also to its treatment. The duct was washed once. The common comprehensive drug therapy was carried out in dogs within the next five, six days. At the end of the first day, out of the 12 dogs, nine stood independently, the rest - on the second day. On the third day, all animals drank water, responded to stimuli. On the fifth day they were active, taking liquid feed. On the seventh day on their behavior and feeding manner the dogs of this group did not differ from healthy ones. To study morphological changes in pancreas after duct washing, three dogs were withdrawn from the test in one day. At autopsy effusion in peritoneal cavity was not observed. The left lobe of pancreas was a little bit shorter. Place of dissection of the tissues of the pancreas and the duct is covered with a blood clot. In the area of duodenum dissection, isolated patches of steatoenecrosis retained. Microscopically, in the duct area dissection changes in pancreas tissues, in general, were the same as in duct dissection without perfusion. At the same time, the plethora for this term was great. Necrotic centers of parenchyma were isolated and with moderate neutrophilic infiltration. Distant from the dissection zone in pancreas tissues there were minor focal hemorrhages with a violation of its structure, however, hyperplasia, foci of neutrophilic infiltration of the interstitial connective tissue were less manifestated. In the proximal part of the duct, the pancreas tissue retained moderate plethora. In addition, there were small foci of hemorrhages with a violation of the structure of individual acinus and slight neutrophilic infiltration in interstitial connective tissue. The latter was also marked by the accumulation of macrophages and the proliferation of fibroblasts, there were isolated areas of hemorrhages. In intact part there was an insignificant edema of interstitial connective tissue. As a result of the conducted experiments, we were convinced of the effectiveness of this method of treating acute pancreatitis.

The article highlights the mechanism of the mathematical model of acinus, the components of the formation of pressure in its cavity and the formation of pancreatic juice. It has been established that the mechanism for creating pressure in the acinus cavity is similar to the intraductal one. In this case, the question remains open about the causes of such high pressure, which is measured in several hundred millimeters of a mercury column, especially since, as histologically established, the pancreas and its ducts do not have muscle structures, and those rudiments of myofibrils, which are noted in some places of the flow system, of course, cannot ensure the development of such pressure. The increase in pressure in the cavity of the acinus is associated with the phenomenon of osmosis in its cells. Since cell membranes have the property of conductivity, as a result of osmosis, water through the membrane first passes from the blood to the cell, then from the cell through the membrane into the acinus cavity. In addition to the mechanism of osmosis through the membrane, in the cells of the acinus epithelium, there is a filtering mechanism through the pores of the layer of connective tissue to the lymph channel. It has now been established that, together with simple osmosis, the phenomenon of electroosmosis takes place in secreting cells and organs of excretion, not only accelerates the transfer of substances, but also increases the pressure on the other side of the membrane against the gradient by almost several first-order units. Thus, the outflow of fluid from the acinus cavity proceeds continuously, but only with a change in the speed of movement, it is determined by the pressure drop in the acinus – tubule – excretory duct system, the opening of the Oddi sphincter and the pulse of the cardiovascular wave, which creates dynamic pressure in the capillary. This whole mechanism, as a result, leads to the filling of the cavity of the acinus and the creation of a certain pressure in it.