Chap, xvii.] THE COLON. 313 



rare. When gradually distended the colon may as- 

 sume enormous dimensions, and it will be readily 

 understood that in some cases of great faecal accumu- 

 lation the thoracic organs may, with certain abdominal 

 viscera, be displaced. In one case, for example, the 

 heart was so displaced by the distended colon that 

 the apex beat was found to be one and a half inches 

 above and one inch to the inner side of the left 

 nipple. When the fsecal collection had been removed 

 it returned to its normal position. Thus it happens 

 that a distended colon is often associated with short- 

 ness of breath, with palpitation, and other thoracic 

 symptoms. 



The right-hand part of the transverse colon is in in- 

 timate relation with the gall bladder, and is commonly 

 found to be bile-stained after death. In some cases 

 where gall stones have been lodged within the gall 

 bladder, the walls of that structure have ulcerated 

 from pressure, the ulceration has involved the sub- 

 jacent transverse colon, and thus a fistula has been 

 established between the gall bladder and the gut, 

 through which large stones have been passed. Hepatic 

 abscesses also have discharged themselves through the 

 transverse colon. 



The anatomical arrangement of the sigmoid flexure, 

 together with its great mobility, render it more 

 liable to obstruction by twist or volvulus, than is any 

 other part of the intestinal tube. The condition that 

 especially predisposes to volvulus is a narrow root to 

 the sigmoid meso-colon, whereby the two ends of the 

 loop of gut are brought close together, and thus a 

 pedicle is formed, which may readily be twisted upon 

 its own axis by any rotation of the loop of bowel. In 

 cases of congenital absence, or deficiency of the rectum, 

 it is commonly advised that the sigmoid flexure be 

 opened in the groin and an artificial anus established 

 there. This operation, known as Littre's operation, 



