578 PUNCTURE OF THE BOWEL. 



made at the wrong place, to the gut slipping off the cannula, to 

 blockage by ingesta, or to movement (or peristalsis) producing a 

 kink in the bowel. The difficulty may be overcome by inserting the 

 stilette and moving the instrument from side to side ; if not, trocar 

 and cannula should be withdrawn and reinserted two or three inches 



Fig. 412. — Abdominal organs seen from below. 

 C, Caecum ; r. v. C, 1st portion of colon ; v. Q, suprasternal flexure ; 

 1. v. C, 2nd portion of colon ; d. Q, diaphragmatic flexure ; D, loops of 

 small intestine ; M, loops of floating colon. 



lower, and if gas should not be obtained, further punctures may 

 be made at points in the lower part of the right flank or behind the 

 last rib. Occasionally owing to failure to afford relief by puncture 

 in the right side, the operation is repeated in the lower region of the 

 left flank. While in marked distension there is no particular objection 

 to operation on the left side, the danger of the trocar transpiercing 



