232 Anatomy Applied to Medicine and Surgery. 



ability, this involvement of the anterior crural is due to 

 mechanical causes the appendix lying near the nerve. 

 In the same way irritation of the bladder may be pro- 

 duced by the contact of the appendix with the ureter and 

 with the plexus of nerves prolonged from the renal and 

 the spermatic plexuses supplying the ureter. There is, 

 of course, a possibility that the bladder complications may 

 be reflex through the superior mesenteric plexus, and then 

 down to the hypogastric plexus. 



In suppurative appendicitis the pus may be situated 

 outside of, or behind the peritoneum, in the recto-peritoneal 

 tissue, and an abscess of this description may be secondary 

 to an intra-peritoneal one, or it may be primary, the in- 

 flammatory action spreading along the connective tissue 

 between the layers of the meso-appendix and thus affect- 

 ing the extra-peritoneal tissues. These abscesses may as- 

 cend behind the colon as high as the posterior surface of 

 the liver, and have been known to perforate the dia- 

 phragm and break into a bronchus, or they may descend 

 into the pelvis, or to the front of the thigh. In the intra- 

 peritoneal variety of appendicular abscess the pus cavity 

 may be postcaecal, or it may be immediately behind the an- 

 terior parietal peritoneum, being walled in by adhesions 

 between the caecum, the small intestines and the omen- 

 turn, or it may be confined to the pelvis or, general in 

 the abdominal cavity. 



Enteroptosis. The small intestine is suspended by the 

 mesentery, the mesenteric vessels, the end of the duode- 

 num and the suspensory muscle of Trietz. Of the large 

 bowel, the ascending and the descending colon are each 

 supported by a short meso-colon, the sigmoid flexure rests 

 on the iliac fossa and in the pelvis, while the transverse 

 colon is retained in its place by the transverse meso-colon, 

 the phreno-colic and the hepato-colic ligaments. In en- 



