THE ABDOMINAL CAVITY 289 



The site of the hernia lies postero-lateral to the oesophageal 

 opening in the diaphragm, as this is normally the last part of 

 the diaphragm to develop. 



Congenital inguinal hernia is dealt with on p. 259. 



The Stomach is almost completely invested by peritoneum, 

 and consequently possesses a wide range of movement. Its 

 proximal or cardiac end, however, is firmly fixed in position 

 owing to its continuity with the oesophagus. It lies behind the 

 seventh left costal cartilage one inch from the median plane, 

 and at a depth of four inches from the anterior surface of the 

 body. On the posterior surface the cardia can be mapped out 

 at a distance of one inch to the left of the ninth thoracic spine. 



The fundus of the stomach is that part of the organ which 

 lies above and to the left of the cardia, when the body is in the 

 supine position. It bulges upwards into the left cupola of the 

 diaphragm, and its upper limit reaches the fifth rib behind the 

 pericardium and apex of the heart. Distention of the fundus 

 with gas may mechanically produce cardiac discomfort by 

 direct pressure. In the erect position, the upward projection 

 of the fundus is diminished, and it tends to become absorbed 

 into the greater curvature. 



The long axis of the stomach is directed downwards, forwards, 

 and to the right. Its antero-superior surface is directed upwards 

 and forwards and lies in relation to the left half of the diaphragm 

 and the inferior aspect of the liver. A large part of this surface, 

 which lies medial to the left costal margin and below the inferior 

 border of the liver, is in direct contact with the anterior abdominal 

 wall. The whole surface helps to form the posterior wall of the 

 supra-colic compartment, which is therefore infected by the 

 perforation of a gastric ulcer situated in this part of the stomach. 



The postero-inferior surface of the stomach looks downwards 

 and backwards, and is in relation with a number of structures, 

 which constitute the stomach-bed. In its upper part, this 

 surface is in contact with the left half of the diaphragm, the left 

 kidney, the left suprarenal gland, and the spleen ; its lower 

 part rests on the pancreas, the transverse meso-colon, and the 

 transverse colon. The two latter structures are supported 

 inferiorly by the underlying coils of small intestine, and together 

 with the pancreas, they form a ledge, sloping downwards and 

 forwards. 



The Greater Curvature forms the anterior, or inferior, border 

 of the stomach. With the body in the horizontal position, it 



19 



