THE CONTENTS OF THE ABDOMEN. 



be entirely concealed behind the cecum, however, and also adherent to the posterior abdominal 

 [f a foreign body is lodged in the vermiform appendix, a resulting inflammatory process 

 may terminate in perforation. Since the appendix is completely surrounded by peritoneum 

 the intestinal contents may flow into the peritoneal cavity, provided that the vermiform process 

 has not been bound down to the iliac fossa and to the neighboring organs by preceding inflam- 

 matory adhesions. 



[The length and direction of the appendix are subject to great variation. According to 

 Wolsey, the directions assumed, in the order of frequency, are as follows: (i) Retrocecal, 

 i. e., upward; (2) pelvic; (3) upward and inward; (4) variable. Allowing for variations, how- 

 ever, the appendix will, in the majority of cases, be found in the right lumbar region, some 

 part of it extending frequently into the adjoining regions. 



The relations of the appendix to the anterior abdominal walls are interesting and important. 

 McBurney's point on the omphalo-spinous line ( 2 J to 3 inches from the anterior spine and 

 at or near the outer border of the rectus) does not, anatomically, exactly represent the base 

 of the appendix, the latter lying somewhere in a circle two inches in diameter with the "point " 

 as its center; it does indicate, however, with sufficient accuracy the seat of the localized tender- 

 ness in cases of appendicitis. ED.] 



The ascending colon (Plates n to 15) runs from the upper portion of the right iliac to the 

 inferior pole of the right kidney. Below or upon this point it is continued into the transverse 

 colon by the hepatic flexure, which produces the impressio colica (see page 131) upon the super- 

 imposed right lobe of the liver. The ascending colon lies upon the quadratus lumborum 

 muscle, to the outer side of the psoas, and is covered by peritoneum only upon its anterior and 

 lateral surfaces; its posterior surface is therefore more or less fixed to the posterior abdominal 

 wall by connective tissue. It consequently does not seem to be freely movable and, particularly 

 in the contracted state, is concealed anteriorly by the overlying intestinal coils. Perityphlitic 

 abscesses are situated in the retroperitoneal connective tissue which fixes the origin of the 

 ascending colon, and occasionally also the cecum, to the iliac fascia. From this situation the 

 suppuration may extend in three directions: 



1. Upward beneath the kidneys as far as the diaphragm; 



2. Downward and inward over the iliopectineal line into the true pelvis; 



3. Downward and forward beneath Poupart's ligament to the subinguinal region of the 

 thigh. 



The transverse colon (Plates n, 14, and 17) commences at the hepatic flexure and runs 

 toward the left in a slightly ascending direction until it reaches the left hypochondrium, where 

 it is continued into the descending colon by the splenic flexure. Although the splenic flexure 

 is somewhat higher than the hepatic flexure, we may say that the direction of the transverse 

 colon generally corresponds to the transverse line connecting the lowest points of the costal mar- 

 gins (Plate n). The transverse colon is concave above and convex below in conformity with 

 the overlying greater curvature of the stomach. Upon the right the colon is covered by the liver 

 and the gall-bladder, upon the left it is in contact with the inferior pole of the spleen, and the 

 first part of the descending colon rests upon the lower portion of the anterior surface of the left 

 kidney. The inferior margin of the transverse colon borders upon the coils of the small intestine. 



