A New Method for Biopsy of Lesions of the Head of the Pancreas

Undoubtedly one of the most perplexing problems of general surgery is the finding of a firm mass in the head of the pancreas during operation on the gallbladder or common bile duct. Since subacute or chronic pancreatitis localized in the head of the pancreas is often associated with gallbladder disease, such a mass, when found in the presence of chronic cholecystitis and cholelithiasis, is often mistakenly assumed to be benign. Recently, I performed two cholecystectomies for chronic cholecystitis with cholelithiasis and explored the associated enlarged common bile ducts. In each instance, the common bile duct was opened about 2 cm. distal to the junction of the cystic duct, the ampulla of Vater was explored with scoops, and dilators were introduced through the sphincter of Oddi in both cases with some difficulty. The thickening of the head of the pancreas that was observed could easily have been attributed to associated chronic