296 SURGICAL APPLIED ANATOMY. [Chap. xvn. 



are so imperfectly covered with the serous membrane 

 that a wound of those organs need not involve it, 

 nor need it be implicated in even extensive inflam- 

 matory changes. Large abscesses may, for instance, 

 form about the kidney and discharge themselves 

 through the skin without any peritonitis being 

 induced. Spontaneous perforation of the small intes- 

 tine must involve the peritoneum, while, on the 

 other hand, the caecum and descending colon may 

 become perforated and the matter escape into the 

 subserous tissue, without the serous membrane being 

 in any way involved. It is a strange fact that it is 

 singularly easy to set up inflammation of the perito- 

 neum if the membrane be approached from its inner 

 surface, but comparatively difficult if it be approached 

 from without. Thus a small puncture of the mem- 

 brane may, on the one hand, lead to fatal peritonitis, 

 while, on the other, it may be extensively torn 

 from its attachments (as in ligaturing the common 

 iliac artery from the side) without any peritonitis 

 following. Or, again, a little pus escaping on the 

 inner surface of the membrane may lead to inflam- 

 mation, while the outer surface may be bathed with 

 pus for a long while (as in large perityphlitic 

 abscesses) without any peritonitis being produced. 

 Inflammation of the peritoneum may lead to the 

 formation of a great variety of bands and adhesions, 

 beneath which pieces of intestine may be caught and 

 strangulated. 



The peritoneum will allow of very considerable 

 stretching, if only that stretching be effected gradu- 

 ally. This is frequently seen in cases of gradual dis- 

 tension of the bowel, and in the formation of the 

 sac in hernia. Abrupt stretching of the membrane 

 leads to certain rupture of ifc. The parietal peri- 

 toneum may be ruptured by violence without damage 

 to any of the viscera. 



