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Jaundice occurring in patients with pancreatitis is usually due to hepatocellular injury or to associated biliary tract disease. Common duct obstruction is occasionally caused by pancreatic fibrosis, edema or pseudocyst in patients who have neither hepatocellular injury nor biliary tract disease. We have studied 7 patients with obstructive jaundice due to pancreatitis who demonstrated no other known cause for jaundice. The difficulty in making the differential diagnosis between benign and malignant disease in these patients, particularly when no pain is associated with obstructive jaundice, is discussed. In view of the fact that the terminal common duct traverses the pancreas, it is uncertain why obstructive jaundice associated with chronic pancreatitis does not occur more often unless the condition is sometimes transient and overlooked. Operative intervention is required in those patients in whom jaundice is persistent. Operation is intended to decompress the biliary tract and the pancreas. The approach used will be dictated by the operative findings in each patient.

Penetrating injuries of the thoracic and abdominal aorta are controlled and repaired successfully with increasing frequency. Penetration of the suprarenal abdominal aorta has been associated with a high mortality rate because of difficult exposure and associated injuries. Between January 1969 and July 1973, 28 patients have undergone operative treatment for traumatic injury to the suprarenal aorta and other associated thoraco-abdominal injuries with 10 long-term survivors. Eight survivors sustained their injuries during the last 3 years, when a medial mobilization of the viscera was the preferred approach. Dacron prosthetic material was employed in seven patients, and in two there was ligation of the celiac axis. With satisfactory exposure, control of exsanguinating hemorrhage, and utilization of available vascular reconstructive techniques, successful management of this relatively inaccessible intra-abdominal lesion can be accomplished in an increasing number of patients.