432 C. R. BARDEEN 



of the abdominal cavity and comes to lie below the pyloric end of 

 the stomach and the liver in the right hypochondriac region. The 

 entero-colic loop viewed from in front thus undergoes torsion in 

 a direction opposite to the movement of the hands of a watch. In 

 the cases now under discussion either no torsion takes place during 

 the return of the intestines, as in Huntington's case (fig. 10), or, 

 much more rarely, reverse torsion takes place, as in Strehl 's case 

 (fig. 11). It is not improbable that the same conditions which 

 make difficult the normal development of the jejunal coils from 

 the duodeno-jejunal loop also make difficult the normal return to 

 the abdomen of the coils developed from the umbilical loop. 



We may, however, have an apparently nonnal development of 

 the left colic loop and of the duodeno-jejunal loop and, neverthe- 

 less, have a return of the umbilical part of the intestines into the 

 abdominal cavity without torsion. In a case of this kind, illus- 

 trated by Jaboulay,'^ the colic loop and the abdominal coils of the 

 jujunum appear to be essentially normal while the umbilical por- 

 tion of the colon lies in the mid abdominal region with the caecum 

 in front of the bladder and the umbilical coils of the small intestine 

 (ileum) occupy the right side of the abdominal cavity. 



Normally, after the caecum has passed from the umbilical cord 

 into the right hypochondriac region, the proximal portion of the 

 colon gradually becomes lengthened and bent toward the right 

 iliac fossa and the caecum is thus brought to its adult position. 

 Meanwhile a further rotation of the proximal part of the colon and 

 of the ileum takes place so that the ileac coils come to life in front 

 of the caecum and the ileum enters the caecum from the left side. 

 The colic portion of the mesentery of the entero-colic loop be- 

 comes fused to the dorsal abdominal wall beginning where the 

 superior mesenteric artery crosses the duodenum and extending 

 toward the caecum. To the left of where the superior mesenteric 

 artery crosses the duodenum the mesentery is fused to the ventral 

 surface of the duodenum. At the left inferior margin of the area 

 of fusion of the colic mesentery we have the line of origin of the 

 free mesentery of the small intestines. The portion of the small 



^ Province mod., 1891, cited by Fredet in Poirier and Charpy, Traite d'anat- 

 omio humaine, T. 4, fig. 472. 



