ABDOMINAL VISCERA IX MAX. 179 



inferior surface of the pancreas, and usually overlapped some- 

 what by its commencing anterior border, the flexure follows 

 that gland in its variations in level. This overlapping part of 

 the pancreas, situated on the vertebral column just to the left 

 of the middle line, is the least movable part of the gland ; 

 the tail being more freely moved by the stomach, and the head 

 of the pancreas, with the contiguous duodenum, being more 

 directly exposed to the displacing force of an enlarged liver. 



There were 6 cases in which the upper border of the 

 duodeno-jejunal flexure was in the plane of E.F. ; 16 cases in 

 which it was not more than 2 cm. above E.F. ; and 8 cases in 

 which it was not more than 2 cm. below ; making in all 

 30 cases, or 75 per cent, of the total cases in ^vhich the upper 

 harder of the duodeno-jejunal flexure was not situated more than 

 2 cm. away from E.F. one way or the other. More than 2 cm. 

 above E.F. there were 3 cases, No. 31 (3"o cm.), Nos. 5 and 6 

 (4 cm.). These were all cases in which the stomach was highly 

 situated, mostly pushed up by distended intestines. Three 

 of the cases in which it was more than 2 cm. below E.F. were 

 not more than 2'5 cm. below. The lowest cases were No. 39 

 (3 cm.), Nos. 15 and 7 (4 cm.), and No. 2 (6 cm.) below E.F. 

 These were all cases with a low, distended stomach, and with 

 a low position of the liver (least marked in case 39). 



It will be seen, however, that in some other cases (especially 

 in Nos. 24, 34, and 38), in which the stomach was low down 

 and more or less distended, the duodeno-jejunal flexure was not 

 lower than usual. If the plates of these cases be looked at, 

 they will show that the liver, though low down, did not directly 

 press on this part of the duodenum. 



The duodeno-jejunal flexure may be fairly said to be the 

 most stable of the duodenum. Its position variations again 

 indicate, as in the case of the pylorus and the first part 

 of the duodenum, that a distended stomach, in the absence of 

 an enlarged or downwardly displaced liver, is not sufficient to 

 cause its material downward displacement. 



