ABDOMINAL VISCERA IN MAN. 283 



where the ascending colon passes into the hepatic flexure is 

 described in the tables as the highest point of the hepatic flexure 

 of the colon. As a matter of fact, the bowel mostly bulges a 

 little higher on an anterior plane before forming a downward 

 loop, but as this point is the most stable part of the flexure, it is 

 the most serviceable for purposes of measurement. 



Shape.— There appear to be two chief varieties in the shape 

 of the transverse colon, determined by the presence or absence 

 of a loop downwards from the hepatic flexure. 



1. The loop would appear to represent a permanence or 

 exaggeration of the primitive bend of the colon at this place. 



The commonest variety of transverse colon is that which 

 presents a downward hepatic loop, of which cases 19, 20, 21, 25, 

 and 26 may be taken as examples. In these cases the trans- 

 verse colon at its commencement bends more or less directly 

 downwards for a variable distance in front of and to the inner 

 side of the ascending colon, and then passes upwards again 

 nearer to the middle line to about the level of its hepatic 

 flexure, and thereby completes a loop downwards. It then 

 passes more or less obhquely upwards across the abdomen to 

 the left side along the lower border of the greater curvature of 

 the stomach. 



At the left side, under cover of the ribs, it usually forms 

 a loop for a variable distance upwards on an antero-posterior 

 plane, the posterior or distal limb of the loop passing down- 

 wards until it reaches the basal surface of the spleen, across 

 which it is directed backwards to the posterior abdominal wall, 

 where it turns abruptly downwards as the descending colon. 



The hepatic loop downwards of the transverse colon is often 

 very firmly fixed and difficult to undo, and the peritoneum 

 attached to the lower part of the downgoing limb of the loop 

 is frequently shortened, and there are commonly adhesions 

 between this downgoing limb and the adjacent ascending colon. 

 Perhaps the tendency to form adhesions at this place is favoured 

 by the bowel contents having better opportunity in this some- 

 what stable and more or less abrupt bend to set up a certain 

 amount of irritation. This hepatic loop downwards of the 

 transverse colon was present in 22 cases or 55 per cent. 



2. In several cases, as in case 11, there was no loop down- 



