THE PERITOXFJM 957 



ciiiiistanci' which is uiikU' use of in suin'a-puliic {■ystntoiiiy. Moreover, as the dis- 

 tt'iuk'd hlackler rises from tlie ])elvis it can detach the serous nieiiil)rane to some 

 extent from the anterior parietes. In extreme distension of tlie hhidder the peri- 

 toneum may he lifted up for some two inches vertically ahove the symphysis. On 

 reaching the os jjubis it is reflected on to the upper part of the l)ladder, covering it 

 as far l)aclv as the base of tlie trigone; thence it is retiected on to the rectum, which 

 it covers in front and at the sides on its upper i)art, or forms for such ])art a distinct 

 meso-rectum. Between the bladder and rectum it forms the recto-vesical pouch. 

 The mouth of this pouch is bounded on eitlier side by a creseentic fold, the plica 

 semilunaris. In the female the peritoneum is reflected from the bladder on to the 

 uterus, which it covers; it then extends so far down in the ])elvis as to pass over 

 the upper part of the vagina behind; thence it extends to the rectum. The i)eri- 

 toneum wliich invests the uterus is retiected laterally to form the broad ligaments. 

 The fold between the vagina and rectum forms the recto-vaginal pouch, or })0Uch 

 of Douglas. The membrane has now bei'n traced back to the s})ine. 



Following it ui)wards, the sigmoid Hexure will be found to be completely cov- 

 ered by peritoneum, a meso-colon attaching the gut to the al)dominal wall. As 

 seen in fig. 561, the ascending and descending colon in cither loin are covered Ijy 

 peritoneum, as a rule, in front and on the outer sides. A little higher up in the 

 median line the peritoneum passes forwards, to enclose the small intestine, and. 

 returning to the spine, forms the mesentery (fig. 563). It now i)asses over tlie 

 third part of the duodenum to the pancreas, from which point it again passes for- 

 wards to form the lower layer of the transverse meso-colon. It invests the trans- 

 verse colon below' and })artly in front, and then leaves it to ])nss downwards to 

 take part in the great omentum. Running downwards some distance, it returns 

 and forms the anterior layer of the omentum. On reaching the stomach it goes 

 over the anterior surface, and at the upper border forms the anterior layer of the 

 lesser or gastro-hepatic omentum, w'hich extends between the stomach and the liver. 

 It invests the inferior surface of the liver in front of the transverse fissure, and, 

 turning over its anterior border, covers the upper surface. At the posterior limit 

 of the upper surface it leaves the liver and goes to the diaphragm, forming the 

 superior layer of the coronary ligament. It covers the anterior part of the dome 

 of the diaphragm, and, once more reaching the anterior al)dominal wall, can be 

 followed to the umbilicus, where it was first described. On reference to tlie dia- 

 gram (tig. 563), the student might be led to suppose that the two sacs as above 

 described are (juite separate. This, of course, is not the case; but in a longitudinal 

 section of the body made anywhere to the left of the foramen of A\'inslow, it is 

 impossible to show the direct connection between the two sacs. 



The peritoneum has only been traced in this longitudinal section so far as it 

 concerns the greater sac. It now remains to follow upon the same section such 

 part of the mein])rane as forms the lesser sac. The ])eritoneum here will be seen 

 to cover the posterior surface of the stomach; and from thence it runs U]iwards to 

 the liver, forming the posterior layer of the lesser or gastr()-hei)atie omentum. It 

 reaches the liver behind tlie transve!rse fissure. It covers only a ]iart of its ]»oste- 

 rior surface, and is retiected on to the diaphragm, forming the lowi'r layer of the 

 coronary ligament. It now goes downwards over the hinder part of the dome of 

 the diaphragm to the spine, separated from the latter by the great vessels. On 

 reaching the pancreas it passes forwards, and forms the upper layer of the trans- 

 verse meso-colon. It then covers the upper half of the transverse colon, and 

 descending^ forms the innermo.st layer of the great omentum. It now ascends, and, 

 arriving at the greater curvature of the stomach, ])asses on to its j^osterior wall. 

 At this point its description was commenced. From fig. 562 it will also be evident 

 that the peritoneum forming the lesser sac comes into contact with the spleen, forms 

 one layer of the gastro-splenic omentum, and is in relation with the upper jiart of 

 the left kidney. 



The precise manner in which certain organs — su<-h as the liv<'r. the cax'um. the 

 duodenum, and the kidneys — are invested by ])eritoneum. is dePcril)e<l in theacc«)unt 

 of those viscera. To such accounts the reader is referred for a description of tlie 

 many 'ligaments' (such as those of the bladder and liver) which are formed by the 

 ])eritnneum. 



