THE ABDOMINAL AaSCERA 



By FEEDERICK TREVES, F.R.C.S.,ENn. 



SURGEON IN ORDINARY TO H. R. H. THE DUKE OF YORK ; SURGEON TO AND LECTURER ON SURGERY' AT THE 



LONDON HOSPITAL 



TRE PERITONEUM 



Its general character. — The peritoneum i^; a thin and delicate serous mem- 

 brane wliich lines the cavity of the abdomen from the diaphragm to the pelvic floor, 

 and invests or covers to a varying extent the viscera which that cavity contains. 

 Viewed in its very simplest condition, it may be regarded as a closed sac, the inner 

 surface of which is smooth and perfectly polished, while the outer surface is rough 

 and is attached to the tissues which surround it. Could it be possible for the 

 ]ieritoneum to be removed entire from the body by some process of superhuman 

 dissection, it would appear simply as a huge thin-walled bag. 



In the male subject the peritoneum forms actually a closed sac; but in the 



Fig. 501. — Transverse Section of the Peritoneal Sac at about the Level 



OF THE Umbilicus. 



female its wall exhibits two minute punctures, which correspond to the openings 

 of the Fallopian tulles. That part which lines the walls of the abdomen is termed 

 the parietal peritoneum; that which is reflected on to the viscera is the visceral 

 peritoneum. The disposition of the peritoneum may first be studied by noting its 

 arrangement as made evident in transverse sections of the abdomen at certain levels. 

 The first section to be described shows the peritoneum in its simplest condition. 

 This is a transverse section through the body, at about the level of the ui)per 

 surface of the fourth lumbar vertebra, and therefore about the site of tlie umbilicus 

 (fig. 561). Starting on the inner surface of tlie anterior abdominal parietes, the 

 peritoneum is seen to cover the transversalis fascia, and indirectly the anterior 

 abdominal muscles; then, passing to tlie left, it lines the side of "the abdomen, 



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