PERITONEUM 



937 



of the falciform ligament of the liver, they may 

 both be slipped along on the free surface of the 

 anterior parietal portion of the peritoneum in a 

 direction at first upwards, then slanting, then 

 backwards, until they are each of them arrested 

 in a corner, or cul-de-sac. They have passed 

 along first on the peritoneal lining of the an- 

 terior abdominal muscles, and afterwards on 

 that of the diaphragm. They are now arrested 

 from being slipped along any further in the 

 same direction by the peritoneum leaping 

 ticross, or extending across, from the lower sur- 

 face of the diaphragm to the upper surface of 

 the liver. In order to pass them along any 

 further on the peritoneal surface they must be 

 carried off laterally or slipped downwards over 

 the upper surface of the liver. We will pursue 

 the latter course. The corners, or cul-de-sacs, 

 in which we suppose the fingers to rest, are 

 those formed by the falciform ligament, the 

 liver, the diaphragm, and the coronary liga- 

 ment all meeting together : the latter is the 

 name given to that portion of the peritoneum 

 which extends across between the diaphragm 

 and the liver. 



First, then, let the finger which is placed 

 on the left side of the falciform ligament be 

 slipped down over the upper surface of the 

 left lobe of the liver, round its anterior edge, 

 and backwards along its inferior surface ; it 

 will be arrested by a membraniform sheet ex- 

 tending across from the fissures of the liver to 

 the lesser curve of the stomach, called the lesser 

 or gastro-hepatic omentum. There for the 

 present we leave it, and now let the other 

 finger be in like manner passed down over the 

 upper surface of the right lobe of the liver, 

 around its anterior surface, and backwards along 

 its under surface, either over the gall-bladder 

 or to the right of it : behind the neck of the 

 gall-bladder, by giving it a direction inclining 

 towards the left, it may be slipped behind the 

 same sheet as arrested the other finger ; that is 

 to say, it may be brought to rest upon the pos- 

 terior surface of the lesser omentum, upon 

 whose anterior surface we left the other finger. 

 This position it gains by being slipped along 

 on the narrow isthmus of liver called lobulus 

 caudatus situated behind the portal fissure, 

 in doing which it passes through a kind of fo- 

 ramen, called the foramen of VVinslow, whereof 

 the lobulus caudatus is the superior boundary. 

 The inferior boundary of this so-called foramen 

 is formed by the duodenum ; the posterior by 

 the vena cava; and the anterior by the vena 

 poitae, the gall-duct, and the hepatic artery. 

 These are the organs and vessels which sur- 

 round the foramen of Winslow : they are, how- 

 ever, all covered by peritoneum in such a 

 manner that the finger passed round the fora- 

 men, which is about one inch in diameter and 

 of a somewhat semicircular form, glides around 

 on a continuous circle of peritoneum. 



The free surface of the lower aspect of the 

 right lobe of the liver has been seen to extend, 

 through the foramen of Winslow, along the 

 lobulus caudatus ; the continuity of surface of 

 course extends to the lobulus Spigelii, from 

 whence it may be traced towards the left and 



forwards to the posterior aspect of the lesser 

 omentum, and backwards to the posterior 

 abdominal parietes. 



The finger being placed on that part of the 

 peritoneum which covers the right kidney, it 

 may be made to glide along the free surface 

 up to the posterior boundary of the foramen 

 of Winslow, and into the foramen itself, which 

 demonstrates the peritoneal continuity in this 

 direction. In much the same way the finger 

 may be slid along on the duodenum until it is 

 thereby conducted into the foramen. 



With regard to the continuity of the perito- 

 neal surface of the anterior boundary of the 

 foramen of Winslow, if the finger be placed 

 on the anterior surface of the lesser omentum 

 and slid along on it towards the right, it comes 

 to a free edge thickened by the vessels and 

 duct mentioned above; doubling around this 

 edge it may be made to glide into the foramen ; 

 thus demonstrating that the anterior and poste- 

 rior surfaces of the lesser omentum are con- 

 tinuous with one another around the vessels 

 and duct that thicken its free border and form 

 the anterior boundary of the foramen of Win- 

 slow. 



Now since, as we remarked above, a free 

 peritoneal surface always indicates a layer of 

 peritoneum, the lesser omentum having two 

 free surfaces consists of two layers ; and its two 

 surfaces being continuous around the vessels 

 mentioned, its two layers are continuous in like 

 manner. It, therefore, is a portion of perito- 

 neum doubled or folded upon itself, enclosing 

 vessels and a duct in the extremity of the fold ; 

 just as we saw was the case with the falciform 

 ligament enclosing, in the extremity of its fold, 

 the obliterated umbilical vein. 



When a double peritoneal sheet passes across 

 from one bowel to another, or from the parietes 

 to a bowel, it is described as attached along the 

 lines where it first lights upon or comes in con- 

 tact with such parts. Speaking in such a way, 

 the lesser omentum is attached to the liver and 

 stomach by the whole extent of its borders, 

 except that small portion between the duode- 

 num and porta which is free : and in fact this 

 border is said to be free only because that which 

 it encloses is small ; if the gall-duct were an 

 inch in diameter, the right border of the lesser 

 omentum would be said to be attached to the 

 gall-duct. Disregarding at present the last 

 observation ; the line of attachment, then, of the 

 lesser omentum is continuous all around except 

 at its free border. Let us trace this line of 

 attachment from the porta of the liver to the 

 pyloric end of the stomach in the circuitous 

 direction in which alone it can be done. From 

 the porta, then, we trace this line along the 

 posterior half of the antero-posterior fissure of 

 the liver, inclining a little to the left of this fis- 

 sure so as to reach the cardiac end of the sto- 

 mach, and thence along the lesser curvature of 

 the stomach to the pylorus. 



The gastric attachment of the lesser omen- 

 tum is placed transversely, whilst its he- 

 patic attachment runs antero- posteriorly, with 

 only a moderate inclination from side to side, 

 so that this omentum has a kind of twist. 



