1412 



SUKFACE AND SUEGICAL ANATOMY. 



gastrointestinal canal. Inflammatory infections of the peritoneum are therefore 

 almost always secondary to lesions of the viscera. The peritoneal lymph sac is 

 brought into direct communication with the subperitoneal lymph vessels of the 

 diaphragm through stomata which open upon the peritoneum covering the abdominal 

 surface of that muscle. With the object, therefore, of diminishing septic absorption 

 after operations for peritonitis, the patient is kept in the half-sitting posture, and 

 pelvic drainage is established. The healthy peritoneum, in virtue of the vital action 

 of its endothelial cells, is endowed with great absorptive properties, and, when irritated, 



has the power of throwing out an 

 abundant exudation, the cell- 

 elements of which are actively 

 phagocytic. 



The reflection of the peritoneum 

 and its relations to the various 

 organs have been fully described in 

 the section on the Digestive System. 

 The attachment of the transverse 

 mesocolon to the posterior abdominal 

 wall is at the level of the first 

 lumbar vertebra, and lies, therefore, 

 a little above the infracostal plane. 

 The attachment, which ascends 

 slightly as it passes from right to 

 left, crosses the right kidney, the 

 descending part of the duodenum, 

 and the head of the pancreas, after 

 which its attachment follows the 

 anterior border of the pancreas. The 

 peritoneal subdivision above this 

 attachment is roofed in by the dia- 

 phragm, and includes the superior 

 part of the great sac, and, behind 

 it, the larger portion of the omental 

 bursa. The organs related to this 

 area of the peritoneum are the liver, 

 along with the bile-ducts and gall- 

 bladder, the stomach and part of 

 the duodenum, the spleen, the 

 pancreas, the upper parts of the 

 kidneys, and the suprarenal glands. 

 Suppuration connected with any of 

 these organs is liable to spread up- 

 wards under the cupola of the dia- 

 phragm,, producing what is known 

 as subphrenic abscess. 



The attachment of the mesentery 

 of. the small intestine extends from 

 the left side of the second lumbar 



Fro. 1102. LATERAL ASPECT OP TRUNK, SHOWING SURFACE 

 TOPOGRAPHY OF VISCERA. 



R.L. Right lung. 

 L. Liver. 



R.K. Right kidney. 

 P.L. Pleura. 



vertebra downwards to the right 

 iliac fossa. The attachment may be 



mapped out on the surface by drawing a line from a point on the transpyloric line, 

 one inch to the left of the median plane, to the mid -point of a line drawn 

 horizontally between the right anterior superior iliac spine and the median plane. 



Subdivisions of the Peritoneal Cavity. From the surgical point of view the 

 peritoneal cavity may be arbitrarily divided into four great subdivisions : namely, 

 a supracolic, a right infracolic, a left infracolic, and a pelvic. All these sub- 

 divisions communicate freely with one another behind the anterior abdominal 

 wall, as well as on each side, along the gutter -like channels in the loins. It 

 is along these gutters that pus readily makes its way from the upper part of 



