978 



HUMAN ANATOMY. 



The Large Intestine. — The two sets of lymphatic net-works characteristic of 

 mucous membranes occur in the walls of the large intestine, and they communicate 

 with one another and finally open into a subserous net-work from which collecting 

 stems take origin. In the vermiform appendix (Fig. 820) these collecting stems are 

 from three to live in number and pass upward in the mesenteriole to terminate in 

 the appendicular nodes or, in the absence of these, directly in the ileo-caecal nodes. 

 The subserous net-work of the base of the appendix communicates freely with that of 

 the caecum, whose collecting stems have essentially the same course as those of the 

 appendix, passing primarily to the appendicular nodes situated in the neighborhood 

 of the ileo-caecal junction and thence to the ileo-csecal nodes. The ultimate nodes 

 of the appendicular and caecal systems are situated in the root of the mesentery along 

 the course of the superior mesenteric vessels ; they belong to the group of mesenteric 

 nodes and receive their afferents in part from the ileo-caecal nodes. 



Communications have been described as existing between the appendicular lymphatics 

 and those of the broad ligament of the uterus as well as the iliac nodes. The more recent 

 observations have failed, however, to confirm the existence of any direct connection with 



these structures, and patholog- 

 FiG. 820. ical conditions of the broad 



ligament and iliac nodes asso- 

 ciated with acute appendicitis 

 may perhaps be due to a 

 dissemination of the infection 

 through the subperitoneal net- 

 work by*^vay of the so-called 

 appendiculo-ovarian ligament. 



The collecting stems 

 from the subserous net- 

 work of the ascending colon 

 pass primarily to some in- 

 constant mesocolic nodes, 

 situated along the line of 

 attachment of the colon to 

 the abdominal wall, and 

 thence are continued along 

 the lines followed by the 

 right colic vessels to the 

 superior mesenteric nodes. 

 The stems from the trans- 

 verse colon have 



Ileum 



Appendicular 

 node 



appendix 



Ileo-caecal and appendicular lymphatic nodes and vessels 

 {Poly a and Navratil .*) 



verse colon have a more 

 varied course in accordance with the arrangement of the blood-vessels. They pass 

 primarily to a series of mesocolic nodes situated between the layers of the transverse 

 mesocolon close to the intestine ; these are of larger size and more numerous than 

 the nodes associated with either the ascending or descending colon and are especially 

 well developed toward either angle of the colon. Their efferents pass principally 

 to some four or five nodes situated along the course of the middle colic vessels and 

 thence to the third group of mesenteric nodes, but those from the vicinity of the 

 splenic flexure follow the course of the branches of the left colic vessels and so pass 

 to the nodes of the median lumbar group situated in the neighborhood of the inferior 

 mesenteric artery. The lymphatics of the transverse colon communicate somewhat 

 extensively with those of the great omentum, as the result of the attachment of the 

 latter to the colon, and they are thus placed in connection with the inferior gastric 

 and splenic nodes. 



The collecting stems from the descending colon and sigmoid flexure pass 

 primarily to mesocolic nodes situated close to the attached surface of the intestine, 

 and thence follow the courses of the left colic and sigmoid vessels to the median 

 \umbar nodes situated in the vicinity of the origin of the inferior mesenteric artery. 



* Deutsche Zeitschrift f. Chirurgie, Bd. Ixix, 



