The Intestines. 233 



teroptosis the intestines, as a whole, are displaced down- 

 wards, the vessels and mesentery being stretched. This 

 condition is a part of the general state of visceroptosis, to 

 which the name Glenard's disease is applied, and in which 

 the hepatic flexure of the colon is the first portion of the 

 intestine to be displaced. In enteroptosis, the lower ab- 

 dominal region is distended, while the upper part is flat- 

 tened. 



In hernia, in addition to the protrusion of the bowel 

 through the abdominal walls, already referred to, the in- 

 testine may become involved in the fossa duodenalis ; in 

 the foramen of Winslow; or in the intersigmoid fossa 

 situated beneath the sigmoid meso-colon. When strangu- 

 lated in these situations, the symptoms differ in no partic- 

 ular from strangulation of the bowel occurring elsewhere 

 in the abdominal cavity. 



Obstruction of the bowels. The more common 

 causes of obstruction of the bowels are : 1. Strangu- 

 lation by bands or through openings; 2. Intussusception; 

 3. Volvulus. The first affects chiefly the small intestine; 

 the second, the ileo-csecal region especially, and the third, 

 the sigmoid flexure. In strangulation by bands, the lat- 

 ter may be peritoneal adhesions that have become stretch- 

 ed and moulded by the movements of the intestine so as to 

 be cord-like in form, or the band may be an elongated ad- 

 herent omentum or a persistent Meckel's diverticulum. 

 The usual manner in which strangulation occurs under 

 the above circumstances is for the bowel to become en- 

 gaged under a band, which, forming a bridge or arch, 

 prevents disengagement. In intussesception one por- 

 tion of the bowel is invaginated into another and, of the 

 different situations in which this may occur, the csecal re- 

 gion is found most frequently involved. The ileo-caecal 

 variety is the most common, forming, as it does, about 45% 



