212 Anatomy Applied to Medicine and Surgery. 



suited in the adhesion of this coat to the contiguous struc- 

 tures. It is very fortunate that such a large percentage 

 of ulcers are situated on the posterior wall, rather than on 

 the anterior, since the posterior surface is normally in con- 

 tact with the peritoneum covering the diaphragm, pan- 

 creas, etc., and septic peritonitis, therefore, the result of 

 perforation, would not be so apt to occur in this case, as 

 it would, were the anterior surface involved, since the lat- 

 ter is some distance from the structures that lie in front of 

 it. Lindner gives the following table to illustrate the 

 relative frequency of the site of gastric ulcer and of the 

 occurrence of perforation : In two hundred cases of gastric 

 ulcer, one hundred and ninety will be on the posterior wall 

 and ten on the anterior ; of the one hundred and ninety, 

 four will perforate, and of the ten, eight and a half will 

 perforate. Should perforation, of an ulcer, situated on 

 the posterior wall, occur before adhesive union of the con- 

 tiguous peritoneal surfaces has taken place, then the cavity 

 of the lesser omentum will be the part affected, with the 

 result, that the inflammatory products will likely be con- 

 fined to this sac, and one form of subphrenic abscess de- 

 velop. This cavity of the lesser omentum is bounded 

 above, by the liver and the diaphragm ; below, by the re- 

 flection of the peritoneum, which, forming the great 

 omentum, goes to the upper surface of the transverse co- 

 lon; in front, by the gastro-hepatic omentum, the pos- 

 terior surface of the stomach and the anterior boundary 

 of the great omentum; behind, by the peritoneum cover- 

 ing the diaphragm, the pancreas, etc., while, laterally, it 

 reaches from the foramen of Winslow to the spleen. This 

 variety of subphrenic abscess produces, according to 

 Lloyd, a tumor in the left hypochrondiac, epigastric and 

 umbilical regions, which varies, from time to time, both in 

 size and shape, in accordance with the quantity of fluid in 



