988 THE ORGANS OF DIGESTION. 



In the female we have seen that two pouches exist at the lower end of the 

 peritoneal sac ; a shallow one between bladder and uterus, excavatio vesico-uterina ; 

 a posterior deep one between rectum behind and uterus and cervix and upper end of 

 vagina in front. The deepest part is bounded on each side by a sharp semilunar 

 fold as in the male, which folds are called sacro-uterine ligaments, or, according to 

 some, recto-uterine. They pass from the upper part of the cervix in front and 

 extend backward to the sides of the rectum toward the sacrum. This pouch has 

 anteriorly the supravaginal cervix uteri and the upper fifth of the posterior wall 

 of the vagina, and posteriorly the rectum and sacrum ; it is the recto-vaginal pouch 

 or the proper cul-de-sac of Douglas. The space above this, between rectum and 

 uterus, is called the recto-uterine pouch. 



On either side of 'the uterus the peritoneum forms a broad double layer pass- 

 ing to the side of the pelvis. It is called the broad ligament, and each contains 

 three important structures, anteriorly the round ligament of the uterus, in the 

 middle and highest up the Fallopian tube, and posteriorly the ovary. 



In a distended condition of the pelvic organs the pouches are filled by them, 

 otherwise coils of small intestines and usually a part of the sigmoid flexure fall 

 into the pelvic cavity. 



The Visceral Peritoneum. 



By this term one understands in general the prolongations of the peritoneum 

 into its own cavity, usually from behind, covering or nearly surrounding a viscus. 

 It is also applied to prolongations from parietal layers and those Avhich pass bridge- 

 like from one organ to another. 



In the middle line, the peritoneum accompanies in its course from the 

 umbilicus to the diaphragm the extraperitoneal obliterated umbilical vein, forms 

 a fold around it which on one hand follows the vein (lig. teres) to the under sur- 

 face of the liver, and on the other continues itself to the upper surface of the 

 liver, and from there passes to the diaphragm as the lig. suspensorium hepatis. 

 It covers the concave surface of the diaphragm as far as the spot where the liver 

 comes into direct contact with it and then passes upon the liver in a frontal direc- 

 tion as the anterior (or upper) layer of the lig. coronarium hepatis (coronary and 

 lateral ligaments). The left leaf of the suspensory ligament passes out over the 

 upper surface of the left lobe of the liver, meeting above the left part of the coro- 

 nary ligament, and the right leaf passes over the upper surface of the right lobe 

 in the same manner. After clothing the convex surface of the liver it advances 

 over the anterior acute margin and then covers the quadrate lobe to the portal 

 fissure, the gall-bladder except where adherent to the liver, and under surfaces 

 of the right and left lobes, to turn finally back to the diaphragm, forming the 

 lower layer of the coronary and lateral ligaments. There is but one place, the 

 portal fissure, where this layer does not turn back. Here by the out- and ingoing 

 vessels it is obliged to descend to the stomach. 



Farther to the left the peritoneum goes from the diaphragm to the stomach 

 (cardia) as the lig. phrenico-gastricum covering the anterior and left surfaces 

 of the oesophagus ; it descends from the diaphragm to the spleen as the lig. 

 phrenic o-lienale or suspensory ligament ; and to the splenic flexure of the colon 

 as the lig. phrenic o-colicum. 



From the fundus of the stomach, the peritoneum passes in a duplicature to the 

 spleen as the lig. gastr o-lienale (gastro-splenic omentum), which covers the gastric 

 surface of the spleen and is continued over its phrenic and renal surfaces as we 

 have seen. 



This omentum descends over the splenic flexure of the colon and there may 

 be called omentum colicum; thence it is connected with the posterior abdominal 

 wall and descending colon. 



The peritoneum leaves about one-third of the posterior surface of the left 

 colon uncovered, forming no mesocolon usually ; below, it surrounds the sigmoid 

 flexure, forming a long mesentery, which follows it into the pelvis. 



