1414 SUKFACE AND SUKGICAL ANATOMY. 



the abdomen along the lumbar regions into the iliac regions, and thence into the 

 pelvis ; and, on the other hand, the pus may ascend from the pelvis along the same 

 channels, especially when the patient is in the recumbent posture. 



The highest (subphrenic) region of the supracolic compartment is further sub- 

 divided into a right and left portion by the falciform ligament. 



The omental bursa may be looked upon as a diverticulum of the first-mentioned 

 subdivision. 



The subphrenic lymph plexus communicates, by means of lymph vessels 

 which pierce the diaphragm, with the subpleural plexus on its superior surface; 

 hence pus confined under tension in either of these spaces is liable to give rise 

 to secondary infection of the corresponding pleural cavity. By adhesions of the 

 transverse colon and greater omentum to the anterior abdominal wall, the supra- 

 colic subdivision of the peritoneal cavity may become more or less completely shut 

 off from the rest of the abdomen. Suppuration in the right half of the phrenico- 

 colic subdivision is generally secondary to leakage from an ulcer of the first part 

 of the duodenum or to disease of the gall-bladder and bile-ducts ; while the left 

 half of the space is more usually infected from the stomach. The best method of 

 draining the supracolic subdivision of the peritoneal cavity is to pass a tube through 

 the hepato-renal pouch of Morrison. The entrance to this pouch lies lateral to the 

 gall-bladder between the inferior margin of the liver above and the right flexure of 

 the colon below. The bottom of the pouch is formed by the reflection of the 

 peritoneum from the superior part of the kidney on to the fascia transversalis cover- 

 ing the aponeurosis of origin of the transversus abdominis muscle below the tip of 

 the twelfth rib. To drain it, a tube is introduced into it either from the wound 

 in the anterior abdominal wall, or, still better, through a puncture opening made 

 through the loin lateral to the kidney, in the angle between the twelfth rib and 

 the lateral border of the sacro-spinalis muscle. Another drainage route is by a 

 tube passed from the wound in the anterior abdominal wall into the omental bursa, 

 through either the gastro-hepatic ligament or the great omentum. 



The right infra-colic subdivision lies above and to the right of the mesentery of 

 the small intestine. It is bounded, above, by the right and middle two-thirds of 

 the transverse colon and the corresponding part of its mesentery, while laterally it 

 is limited by the caecum and ascending colon. At its right inferior angle are the 

 ileo-csecal junction and the vermiform process ; at its right upper angle is the 

 right flexure of the colon, while at its left upper angle is the inferior part of the 

 duodenum, crossed by the superior mesenteric vessels. 



The organs related to this subdivision are, in addition to the parts of the large 

 intestine already mentioned, coils of small intestine, the inferior third of the right 

 kidney, the right ureter, the inferior half of the descending and the horizontal part 

 of the inferior portions of the duodenum. 



Suppuration in connexion with the organs in this area involves more especially 

 the right lumbar region, and may extend upwards along the colon into the sub- 

 diaphragmatic region, or downwards into the pelvis minor. To drain this region 

 a tube is introduced into the right lumbar region either through the anterior 

 abdominal wall or through a stab-wound in the loin lateral to the ascending colon. 



The left infra-colic subdivision, which lies below and to the left of the mesentery, 

 narrows as it passes upwards and reaches to a higher level than the right infra-colic 

 subdivision. Inferiorly, it is directly continuous at the superior aperture of the 

 pelvis with the peritoneal cavity of the pelvis minor. Above, it is bounded by the 

 left third of the transverse colon and its mesentery, and, still more posteriorly, by 

 the inferior surface of the body of the pancreas ; laterally it is bounded by the 

 descending and iliac portions of the colon. At its right upper angle is the duodeno- 

 jejunal flexure, lying immediately to the left of the vertebral column, in the angle 

 between it and the inferior surface of the pancreas. At its left superior angle is 

 the left flexure of the colon, while at its left inferior angle is the junction of 

 iliac with pelvic colon. This subdivision of the peritoneal cavity, in addition to 

 containing the majority of the coils of the small intestine, is related to the inferior 

 third of the left kidney, the left ureter, the lower part of the abdominal aorta and 

 vena cava, and the inferior mesenteric and common iliac vessels. Drainage of this i 



