308 SURGICAL APPLIED ^x ATOMY. [Chap. xvn. 



the spread of disease by continuity of tissue, it is well 

 to note that these two parts of the bowel are only 

 separated by connective tissue from the aorta, vena 

 cava, spine, renal vessels, left kidney, back of the 

 hepatic flexure of the colon, and the head of the 

 pancreas. In the duodenum are Brunner's glands, 

 which are sometimes the seat of a perforating ulcer in 

 cases of burn. They are mostly seated in the first 

 part of this bowel, and the perforation, therefore, 

 usually opens into the peritoneal cavity, the first part 

 of the gut being almost entirely covered by peritoneum. 



The ileum is the part of the intestine that is the 

 most frequently found in external hernise. It is also 

 the part that most usually is involved in cases of 

 strangulation by internal bands, and by the borders of 

 abnormal slits in the mesentery, etc. From one to 

 three feet from the end of the ileum is sometimes 

 seen a diverticulum (Meckel's) that represents the 

 remains of the vitello-intestinal duct. This diverti- 

 culum usually exists as a tube of the same structure as 

 the intestine. Its length varies. It may sometimes 

 extend as a patent tube as far as the umbilicus. It is 

 more often but a few inches long, and may then end in a 

 free conical or globular extremity, or in a fibrous cord. 

 This diverticulum may cause intestinal obstruction in 

 many ways. Its end may contract adhesions, and be- 

 neath the bridge thus formed a loop of bowel may be 

 strangled. It may twist itself about a piece of intes- 

 tine so as to form a knot around it. It may, from its 

 adhesions, so drag upon the ileum as to cause " kink- 

 ing " of the tube at its point of origin. In more than 

 one case it has been found in an external hernia. 



Owing to the presence of the ileo-csecal valve, it is 

 about the ileo-csecal region that obstruction from 

 foreign bodies usually occurs. Foreign bodies that have 

 been swallowed, as well as immense gall-stones that 

 have passed from the gall bladder to the small gut 



