994 THE ORGANS OF DIGESTION. 



artery, throwing forward a fold of peritoneum in relief. This is called the lig. 

 gastro-pancreaticum (Fig. 616). 



The figure shows the posterior wall of the bursa lying in front of the pan- 

 creas. Through the opening to the right and above may be seen the papillary 

 tubercle of the Spigelian lobe. 



The connection of the two bursse is narrowed by the tuber omentale of the 

 pancreas and the gastro-pancreatic ligament which runs obliquely from the cardia 

 to the anterior surface of the pancreas in about the middle line. 



It is now proposed to call the first bursa the atrium bursce omentalis or ante- 

 chamber, and the second bursa the bursa omentalis proper. 



The part behind the stomach persists throughout life. The surfaces are in 

 immediate contact, and by their smoothness and moisture permit easy movements 

 of the stomach in its various degrees of distention. 



Recessus Peritonei or Retro -peritoneal Fossae. 



In four or five different parts of the abdominal cavity there are regions of sur- 

 gical interest from the possibility of the occurrence of retro-peritoneal hernice. One 

 we have already noted, the foramen of Winslow, another is a plirenico-hepatic fossa 

 at the left lobe of the liver. As many as three may occur at the upper end of the 

 root of the mesentery: a duodeno-jejunal and duodenal fossae ; an intersigmoid 

 fossa to the outer side of the sigmoid flexure, & fossa iliaco-subfascialis connected 

 with a left Psoas minor muscle. Finally three fossae may exist in the neighbor- 

 hood of the caecum. 



Henle says of the first one, "It is remarkable that a hitherto overlooked 

 pocket has been brought to light by Von Brunn, 1874. It is on the under sur- 

 face of the diaphragm, of various dimensions, and can be found in about one-half 

 of the adults. It opens to the right from the left margin of the liver and extends 

 to the left, parallel to the coronary ligament, sometimes only deep enough for the 

 introduction of the point of a probe and sometimes distensible to a length of 13 to 

 16 cm. and to a diameter of 3 to 4 cm. Its existence depends on the atrophy of 

 the left lobe of the liver. When the gland substance retracts, a flat peritoneal 

 fold remains on the under surface of the diaphragm, penetrated by vessels and vasa 

 aberrantia of the liver and often lodging separate particles of gland tissue. The 

 pocket fossa phrenico-hepatis originates therefore when the anterior or posterior 

 "edge of the atrophied lobe, by far most frequently the anterior, fuses with the 

 diaphragm. It develops after birth. In new-born and children it is not to be 

 found." 



Duodenal Fossae. 



Jonnesco has found a series of three fossas in the vicinity of the ascending 

 duodenum and duodeno-jejunal angle. They have all generally been called the 

 duodeno-jejunal fossa, or fossa of Treitz. 



1. The inferior duodenal fossa (Fig. 617) is most frequent, and occurs in 

 about 75 per cent, of cases. It is situated to the left of the upper part of the 

 ascending duodenum and has the shape of a cornucopia bound to the intestine. 

 The apex of the fossa is directed to the right and almost touches the root of the 

 mesentery. 



Its widened mouth is turned upward and circumscribed by the free edge of 

 the inferior duodenal fold. This fold is triangular, has a falciform edge with its 

 concavity turned upward ; its right margin rests on the anterior surface of the 

 duodenum and its left on the prerenal peritoneum and is continuous with the 

 parietal peritoneum. It contains no vessels, nor fat, and the duodenum is readily 

 seen through it. The boundaries of the fossa are this fold to the front and left, 

 the ascending duodenum to the right, and the left side of the third lumbar verte- 

 bra behind. Its tip may extend to the anterior surface of the fourth lumbar ver- 

 tebra. The depth may attain 3 cm. ; its orifice admits the tip of the index finger. 



