ABDOMINAL VISCERA IN MAN. 181 



The following four cases represent an abnormality in which, 

 after the usual position of the duodeno-jejunal flexure was 

 reached, there was an additional bend to the right towards, 

 or across, the middle line. In cases 5 (fig. 9) and 32 this addi- 

 tional part was directed to the right transversely, along the 

 anterior border of the pancreas ; in cases 22 and 38 (fig. 9) it 

 was directed downwards and to the right, lying more or less 

 upon the fourth part of the duodenum. In all these cases, as 

 far as the point represented in the illustrations, this additional 

 part of the duodenum was firmly bound down by the peri- 

 toneum. The cases, particularly Nos. 5 and 32, seem to repre- 

 sent some such condition as figured by Treves (15) as existing 

 in the hysena and in the spider monkey, the meso-duodenum 

 having subsequently been entirely obliterated. 



In none of these cases, except in No. 38, was there any duo- 

 deno-jejunal pouch, showing how complete the obliteration of 

 the meso-duodenum had been. Moreover, in three cases, Nos. 5, 

 22, and 32, it is interesting to note what is perhaps further 

 evidence of dragging of the peritoneum over to the right, by the 

 existence of a strong band passing from the liver and gall- 

 bladder to the hepatic flexure of the colon. The band was most 

 marked in case 32. 



The duodenum in case 40 had a very remarkable arrangement 

 (fig. 10). The first part, 2 cm. long, passed outwards, lying on the 

 pancreas in the usual manner. The second part passed downwards, 

 also somewhat as usual, overlying the kidney, its outer border 

 being 6'5 cm., and its inner border 3 cm. from the middle line. 

 At its inner and lower part it bulged inwards beneath the 

 attachment of the colic peritoneum ; otherwise it was entirely 

 behind the peritoneum. The duodenum extended downwards to 

 the iliac crest, and then turned again directly upwards (part 3, 

 fig. 10) beneath its second part, and this third or ascending 

 portion bulged externally beyond the second or descending part. 

 The third part continued upwards for 7 cm., until, a little below 

 the level of E.F., it bent transversely inwards as the fourth part 

 along the plane of E.F., and crossed the middle line, its lower 

 border being 3 to 3-5 cm. below E.F. This fourth part extended 

 for 3'5 cm. to the left of the middle line and then bent abruptly 

 forwards, forming a fifth part which ran back again transversely 



