274 



THE ABDOMEN AND PELVIS 



with the anterior layer of the lumbo-dorsal fascia on its anterior 

 surface. When the edges of the wound are widely retracted, 

 the last thoracic, ilio-hypogastric and ilio-inguinal nerves may 

 be seen running downwards and laterally behind the peri-nephric 



Trapezius 



Latissimus dorsi 



Spleen - - 



Left kidney 4- 



Left ureter 



I Lumbo-dorsal fascia, 

 middle layer 

 Quadratus lumborum 



External oblique 

 4 Sacro-spinalis 



Lumbp-dorsal fascia, 

 posterior layer 



Glutseus maximus 



FIG. 84. The Position and Posterior Relations of the Kidney. 



On the right side, the lower part of the latissimus dorsi has been removed 

 and a rectangular flap of the posterior layer of the lumbo-dorsal fascia has 

 been turned laterally. A part of the sacro-spinalis has been resected, exposing 

 the tips of the transverse processes of the 2nd and 3rd lumbar vertebrae and 

 the middle layer of the lumbo-dorsal fascia. A rectangular flap of the fascia 

 has been turned laterally in order to expose the quadratus lumborum. 



On the left side, the relations of the spleen and left kidney to the lung and 

 pleural sac are indicated on the surface. 



fascia. When the latter is opened, the peri-renal fat can readily 

 be separated from the kidney with the finger. 



When freer access is desired, e.g. in exploratory operations 

 necessitating the exposure of the ureter, the oblique lumbo-ilio- 

 inguinal incision may be preferred. It commences above in 

 the angle between the twelfth rib and the. sacro-spinalis, and is 

 carried downwards and laterally in the direction of the anterior 

 superior iliac spine. If necessary, it may be continued medially 



