PERITONEI'M. 



941 



deficiency of peritoneal investment to the dia- 

 phragm and liver between its anterior and 

 posterior portions allows the liver to adhere to 

 the diaphragm, and small vessels and lym- 

 phatics to pass from the one to the other. 



The triangular ligaments of the liver are the 

 continuations of the layers of the coronary 

 ligament, become adherent as above, leaping 

 across from the rounded posterior corners of 

 the liver to the nearest or postero-lateral portion 

 of the upper concave abdominal parietes, that 

 is to say, to the diaphragm. Their form is, as 

 their name indicates, triangular ; their anterior 

 borders are free; their posterior and internal 

 borders are attached, the former to the parietes, 

 the latter to the liver. They help to keep the 

 liver in situ. 



The lesser omentum has been partially de- 

 scribed above. Between its layers are included 

 the vena portse, the hepatic artery, the gall- 

 duct, and the hepatic plexus, along its free 

 border; and the pyloric and coronariaventriculi 

 arteries, with accompanying veins and nerves, 

 along its gastric attachment. Except in the 

 course of these vessels, it is a thin transparent 

 membranous sheet, with a very small amount 

 of strength. The vessels destined for its own 

 proper nutrition are extremely few and small. 

 With regard to its use, Cruveilhier thinks that 

 it is a true mesentery of the stomach, mesogas- 

 trium, but on this point we would offer the 

 following remarks. One characteristic of a 

 mesentery is, that it retains its bowel in situ, 

 and this office the lesser omentum doubtless 

 partially performs towards the stomach ; but 

 another characteristic of a mesentery is, that it 

 gives passage to the arteries and veins of the 

 bowel to which it belongs, and this office the 

 Jesser omentum performs, not for the stomach, 

 but for the liver. It is the splenic omentum, 

 or that part of the great omentum whereupon 

 the spleen is sessile, extending between the 

 parietal line of attachment running from the 

 cardia to the left bend of the colon, and the 

 fundus of the stomach, that conducts the prin- 

 cipal gastric vessels, as the coronaria ventriculi, 

 vasa brevia, and gastro-epiploica sinistra, from 

 the parietes to the stomach. The splenic omen- 

 tum fulfils indeed both these offices towards 

 the stomach, and occupies with regard to it the 

 position of a parieto-visceral fold, a relation still 

 more characteristic of a mesentery.. We there- 

 fore are inclined to consider the splenic omen- 

 tum as the mesogastrium ; and some facts in 

 comparative anatomy, (figs. 490, 491,) as well 

 as that mentioned above, of its affording transit 

 to the hepatic vessels, seem to indicate that 

 the lesser omentum is the mesentery of the 

 gall-duct and liver. 



The splenic omentum is the name given to 

 that long corner of the great omental pouch 

 which extends up to the left of the fundus of 

 the stomach as high as the cardia. It obtains 

 its name from the circumstance of the spleen 

 being situated on its outer aspect. The spleen, 

 in a certain sense, is included between the 

 layers ; it is invested, however, by the outer 

 layer alone, the inner layer passes by it un- 

 interruptedly. Soemmering mentions a liga- 



ment um phrenico-gastricum, a peritoneal fold 

 connecting the cardiac end of the stomach to 

 the diaphragm ; it is the very uppermost corner 

 of this part of the great omental sac, whicli 

 gets somewhat behind the cardia, and is not 

 unfrequently complicated by one or two small 

 falciform folds, rendered very conspicuous by 

 pulling up the stomach. The attachments of 

 this part of the great omental pouch have 

 already been described ; between its layers are 

 contained, at its very tip or uppermost corner, 

 the arteria coronaria ventriculi, with its accom- 

 panying vein and nerves ;* and lower down the 

 splenic vessels and nerves as far as from the 

 parietes to the spleen, and the branches of the 

 splenic vessels called vasa brevia and gastro- 

 epiploica sinistra, as far as to the fundus of 

 the stomach. There are a few lymphatic 

 glands near the root of the spleen ; such glands, 

 together with fat in variable quantities, are very 

 commonly included between the layers of the 

 peritoneal duplicatures. The use of the sple- 

 nic omentum is to retain the spleen and stomach 

 in situ, and to give transit to the splenic and 

 gastric vessels. 



The great omentum, called also the gastro- 

 colic omentum. The apron-like appearance 

 and the sac-like form of this singular structure, 

 and also its attachments, have been described 

 above; it is necessary to add the following 

 remarks. It extends much further down in 

 the adult than in the fetus. It reaches lower 

 down on the left side than on the right. 

 Owing to the proximity of its lower edge to 

 the femoral and inguinal rings, it frequently 

 constitutes a part or the whole of the contents 

 of hernial sacs. It reaches lowest down when 

 the stomach is empty, and is very considerably 

 drawn up by distension of that organ. It is 

 usually spread apron-like evenly over the small 

 intestines, but is not unfrequently found lying 

 folded up on one side or the other of the 

 abdomen, occasionally even turned up over 

 the liver and stomach. It is frequently loaded 

 with immense quantities of fat, and indeed is 

 seldom or never destitute of it along the sides 

 of the vessels which form such a beautiful 

 net-work between its layers. In the intervals 

 or meshes of this network the omentum is so 

 extremely thin that it is difficult to believe it 

 composed of two layers, and not unfrequently 

 the membrane is deficient in these situations, 

 giving to the whole the appearance of a piece 

 of lace finely perforated. This is always the 

 condition of the great omentum of the dog, in 

 which animal we have repeatedly assured our- 



* The arteria coronaria ventriculi is rarely ac- 

 tually included between the layers of the splenic 

 omentum in the human subject ; the posterior as- 

 pect of the cardiac end of the stomach cominsj into 

 immediate adhesion with the diaphragm, frequently 

 allows of this artery reaching it without beinsr en- 

 closed in any peritoneal duplicature ; not uufre- 

 quently, indeed, it is found to enter the corner of 

 the gastro-hepatic omentum at once, and sometimes 

 it occupies one of the little falciform folds just 

 mentioned, but occasionally it is situated as the 

 description indicates, and as this is its constant 

 course in all or most of the inferior animals, we 

 consider it and describe it as its normal one. 



