314 SURGICAL APPLIED ANATOMY. [Chap. xvn. 



is, it must be confessed, not very successful. One 

 difficulty has been said to depend upon the uncertain 

 position of the sigmoid flexure in cases of congenital 

 deformity, it being sometimes on the right side and 

 sometimes in the pelvis at the middle line. Surgeons 

 have, indeed, advised that in these cases the right groin 

 be always made the seat of operation, since the sigmoid 

 flexure may be found there, and if it is not present in 

 that place there is at least the caecum that may be 

 opened. This procedure would avoid the inconve- 

 nience of opening the left iliac region and finding it 

 unoccupied by bowel. The frequency with which the 

 sigmoid flexure is misplaced in young infants is shown 

 in the following record. In 150 autopsies on young 

 infants, Bourcart found the sigmoid flexure on the left 

 side in 111 cases, on the right in 33, and in the pelvis 

 in 6. In 134 autopsies by Giraldes, the gut was 

 found in its proper place in 114 instances ; and 

 out of 100 like post-mortem examinations on 

 young infants, Curling found it on the left side in 

 85 cases. 



Congenital malformations of the colon. 

 These are of moment with regard to operative pro- 

 cedures. It may be very briefly said, that in the foetus 

 the small bowel occupies at one time the right side of 

 the abdomen, while the large gut is represented by a 

 straight tube that passes on the left side vertically 

 from the region of the umbilicus to the pelvis. The 

 caecum is at first situated within the umbilicus, and then 

 ascends in the abdomen towards the left hypochon- 

 drium. It next passes transversely to the right hypo- 

 chondrium/and then descends into the corresponding 

 iliac fossa. It may be permanently arrested at any part 

 of its course. Thus the caecum may be found about the 

 umbilicus, or in the left hypochondriac region (the 

 ascending and transverse parts of the colon being 

 absent), or it may be found in the right hypochondrium, 



