THE ABDOMEN. 



397 



various abdominal and pelvic organs grow. As the organs increase in size they push 

 farther into the abdominal cavity and the peritoneum covers more of their surface, 

 until in some cases the two layers (anterior and posterior) meet; thus the organ is 

 left hanging by its peritoneal pedicle. The peritoneum covering the organs is called 

 the visceral peritoneum, that lining the walls of the abdominal cavity the parietal 

 peritoneum. Those parts of the peritoneum joining the visceral and parietal layers 

 receive various names. Sometimes they are called ligaments, thus we have the 

 various ligaments of the liver, the coronary, lateral, and suspensory ; of the spleen ; 

 of the uterus; bladder, etc. Sometimes they are called omenta, thus we have the 

 greater omentum, the lesser or gastrohepatic omentum and the gastrosplenic omen- 

 turn. Sometimes they receive the name of mesentery, which is applied to the small 

 intestine, and mesocolon, as applied to the large intestine. From this arrangement 



Coronary ligament 



Lesser omentum 



Foramen of Winston- 



Stomach (pyloric end) 



Pancreas 



Lesser peritoneal cavity 



:ater peritoneal cavity 



Vesico-uterine pouch 



Recto-uterine pouch or pouch of Douglas 



FIG. 412. Anteroposterior section, showing the peritoneum. 



, it is evident that there is some portion of every abdominal and pelvic organ that is 

 not covered by peritoneum. In some organs, as the small intestines, the uncovered 

 part is very small, being at the attachment of the mesentery. In other organs, as 

 the kidneys, it is very large, embracing all their posterior surface. In operating on 

 the abdominal or pelvic organs these attachments are of importance, as a knowledge 

 of them enables the surgeon for example, in operating on the kidney for renal cal- 

 culus to complete his procedures without wounding the peritoneum or opening the 

 peritoneal cavity. The upper and lower limits of the peritoneum are also important, 

 as it is liable to be wounded in operations on the chest and the organs of the pelvis. 

 A knowledge of the course pursued by the peritoneum over the various organs 

 is of service both in diagnosis and operative procedures. 



Viewing the body in an anteroposterior section (Fig. 412), and beginning at the 

 umbilicus, the peritoneum is seen to pass upward on the posterior surface of the anterior 

 abdominal wall until it reaches the under surface of the diaphragm, which it covers, 

 to the upper posterior surface of the liver, where it forms the coronary ligament on 



