THE ABDOMINAL CAVITY 283 



anterior abdominal wall ; posteriorly, it is limited by the lesser 

 omentum, stomach, and greater omentum, which together form 

 an oblique surface, sloping backwards and to the right. When 

 pus or septic fluid, e.g. from a leaking ulcer of the duodenum or 

 anterior wall of stomach, is present in this compartment, it may 

 remain localised owing to adhesions between the greater omentum 

 and the anterior abdominal wall. Its downward spread is thus 

 prevented, and owing to the slope of the posterior wall, the fluid 

 tends to pass into the hepato-renal recess. With the body in 

 the horizontal position it readily spreads from this situation 

 round the free border of the right triangular (lateral) ligament 

 of the liver into the recess between the liver and the diaphragm. 

 The infection of this intra-peritoneal subphrenic area is a very 

 serious condition, because the lymphatics of the peritoneum on 

 the under surface of the diaphragm communicate very freely 

 with those of the pleura, and empysema or abscess of the lung 

 may complicate the existing peritonitis, with fatal results. 



The hepato-renal recess of Morison may be drained through 

 an incision made below the twelfth rib and at the lateral margin 

 of the kidney. This pierces, in turn, the skin, fasciae, latissimus 

 dorsi, the obliques, transversus, transversalis fascia, and 

 peritoneum. A tube thus passed into the recess affords good 

 drainage if the patient is placed in the Fowler (semi-sitting) 

 attitude. In this way the spread of infection into the subphrenic 

 danger zone may be successfully prevented. 



After perforation of an ulcer on the posterior wall of the 

 stomach, the fluid may be prevented from escaping from the 

 omental bursa by adhesions closing the epiploic foramen (of 

 Winslow). The bursa then becomes distended and may best 

 be drained by means of a tube passed through the lesser omentum 

 from the median incision, which is employed in such cases (p. 294). 

 In addition a counter opening may be made in the left side, 

 below the twelfth rib and lateral to the descending colon, and a 

 tube passed upwards and medially in front of the left colic 

 flexure may be introduced into the bursa through the lower 

 part of the gastro-splenic ligament. 



If the epiploic foramen is patent, the fluid passes out into 

 the supra-colic compartment and at once invades the hepato- 

 renal recess of Morison (Fig. 86). In this case, both the recess 

 and the bursa will require to be drained. 



The Infra -colic Compartment lies behind the greater 

 omentum, transverse colon, and meso-colon, and is subdivided 



