Chap, xvii.] THE PERITONEUM. 297 



The great omentum is, from its position, 

 very apt to be wounded. In small wounds of 

 the front of the belly it very often protrudes, 

 and acts as an excellent plug to prevent the 

 escape of other and more important structures. 

 It is often found in hernia, especially in umbilical 

 hernia, where it is almost constant. Its limits 

 vary, and it is said to generally incline to the left. 

 According to Paulet, omental hernise are much more 

 common upon the left side for this reason. The 

 omentum, like other parts of the peritoneum, is apt to 

 inflame, and to contract adhesions to the neighbouring 

 parts. These adhesions are often of the greatest 

 service in limiting inflammatory and hsemorrhagic 

 extravasations, by matting the bowels together and 

 forming spaces between them. In perforation of the 

 bowel from disease, an opportune adhesion of the 

 omentum over the aperture may prevent escape 

 of the intestinal contents. In hernise the omentum 

 generally contracts adhesions to the sac, and be- 

 comes irreducible, or it may form a kind of second 

 sac about the gut itself ("omental sac"). The end 

 of the omentum, by becoming adherent to distant 

 parts, as to the pelvic viscera, may form itself 

 into a firmly attached band, beneath which the 

 bowel may be fatally strangled. In like manner 

 the intestine has been strangulated through slits 

 and holes that have developed in the omentum, 

 usually as a result of inflammatory adhesions. When 

 the great omentum contains much fat it must act as 

 an excellent protection to the bowels, and must, as a 

 layer of non-conducting material, help to maintain 

 the equality of their temperature. 



The mesentery extends obliquely from the attach- 

 ment of the transverse meso-colon, just to the left of 

 the second lumbar vertebra, to the right iliac fossa. 

 From this oblique direction it follows that, when. 



