Chap, xvii.] THE SMALL INTESTINES. 305 



transverse, or nearly so, is about four or five inches in 

 length, and is commonly made across the middle line 

 just above the umbilicus. The diseased part has to 

 be isolated and the omental connections of the right 

 end of the stomach freely divided. The vessels that 

 require most attention are the pyloric branch of the 

 hepatic artery and the gastro-epiploica dextra from 

 the same vessel. The cancer is excised, and the 

 cut end of the duodenum united to the cut edges of 

 the stomach, so as to re-establish the canal. The 

 details of the operation are very complicated, and 

 need not be here more fully dealt with, further than 

 to say that since the section of the stomach must be 

 much greater than that of the duodenum, the aperture 

 in the former viscus is united by sutures until the gap 

 left is equivalent in calibre to that of the divided 

 duodenum . 



The small intestines. The length of the small 

 intestine is about twenty feet, of which eight feet are 

 contributed by the jejunum and twelve by the ileum. 

 The length of the duodenum is about ten inches. 

 The division into jejunum and ileum is quite arbi- 

 trary. There is no one point where it can be said 

 that the jejunum ends and the ileum commences. 

 When the small intestines are exposed by accident or 

 operation, it is often difficult, especially when there 

 is abdominal disease, to recognise the upper from the 

 lower part of the gut. It may be noted, however, 

 that the coils of the jejunum occupy mainly the left 

 lumbar and left iliac regions, and a part of the 

 umbilical area, while the ileum occupies rather the right 

 lumbar and iliac regions, the hypogastric area, and a 

 part also of the umbilical. The jejunum is wider 

 than the ileum (its diameter being a quarter of an inch 

 greater than that of the ileum), and its coats are 

 thicker and more vascular. If the gut be empty, and 

 can be rendered translucent by being held against a 

 u 



