310 SURGICAL APPLIED ANATOMY. [Chap. xvn. 



fatal. The incision is made in one or other iliac 

 region parallel to Poupart's ligament and some little 

 way above it, and to the outer side of the epigastric 

 artery. The cut, which is about three inches in 

 length, extends through the three flat muscles of the 

 abdomen ; the peritoneum is incised, a knuckle of 

 small intestine is secured to the wound and is then 

 opened. 



Resection. Portions of the small intestine have 

 been resected with success for various diseased condi- 

 tions. In one case more than two yards of the small 

 intestine were cut away, and the patient (a young 

 woman) made an excellent recovery. 



The large intestine. From the csecum to the 

 sigmoid flexure, this portion of the bowel is accessible 

 to pressure except at the hepatic and splenic flexures, 

 which are deeply placed. The hepatic flexure is 

 under the shadow of the liver, and the splenic curve, 

 which reaches a higher level, is behind the stomach. 

 The position of the transverse colon can often be well 

 marked out. Tt crosses the belly transversely, so that 

 its lower border is on a level with the umbilicus (Fig. 

 30). In cases of faecal accumulation, the outline of the 

 colon, with the exception of the two flexures above 

 named, may be distinctly defined. In distension of the 

 small intestine the belly tends to present the greatest 

 degree of swelling in front, and about and below the 

 navel. In distension of the larger gut, the front of 

 the abdomen may remain (for a while at least) com- 

 paratively flat, while the distension will be most 

 obvious in the two flanks and in the region just above 

 the umbilicus. Tumours of the transverse colon, and 

 of the lower two-thirds of the ascending and descend- 

 ing colon, can be well defined, even when of moderate 

 size, and in cases of intussusception the progress of the 

 mass along the colon can often be traced with great 

 ease, and the effects of enemata and other methods of 



