THE REGIOXS OF THE ABDOMEN 



120- 



method of delimitation. Firstly, for the hif/her horizontal plane, the mo^ft suitable 

 level appears to be the lowest point of the tenth costal cartilage. This plane passes 

 through the second lumbar vertebra posteriorly, and lies about two inches above 

 the umbilicus in front. It cuts through the stomach, the transverse colon, the 

 ascending and descending colon, the duodenum (lower curvature j and small 

 intestine, and the kidneys. For the lower horizontal jtlane Ave have the choice of 

 two levels — that of the anterior superior iliac spine, whidi lies about an inch below 

 the level of the sacral promontory, and that of the tuljcrculum crista', recently 

 proposed by Professor Cuuningluim. 



The plane of the tuberculum cristse (intertuberculous plane) has been adopted 

 by Quain and Cunningham; but the lower of the two alternative planes, that of 

 the anterior iliac spines, seems the more definite and convenient for clinical demon- 

 stration. 



This interspinous pdane, carried horizontally V>ackwards from the symphysis into 

 the true pelvis, cuts the small intestine, the caecum or lower part of the ascending 

 colon, the sigmoid flexure, the upper end of the rectum, the fundus uteri, the 

 ovaries and Fallopian tubes, and the distended bladder, and hence forms a valuable 

 guide to the surgeon. 



Fig. 771. — Diagram <»f the Abdomixal Regiox.s. 



Joint between meso-ster- 

 num and ensiform cartilage 



Tip of ensiform cartilage 

 Cosiai border 



UPPER HORIZONTAL PUNE 



LOWER HORIZONTAL PLANE A, AT 

 LEVEL Of TUBERCLES OF IL'AC 

 CREST 



LOAER HOmZONTAL PUNE B, AT 

 LEVEL OF ANTERIOR ILIAC SPINES 



VERTICAL PLANE A, FROM UIDDLE OF 

 POUPARTS LIGAMENT 



VERTXAL PLANE B. AT OUTER BOR- 

 DER OF RECTUS iSEMILUNAR LINE) 



SUMMIT OF SVMPHrSIS PUBIS 



For the longitudinal plane on each side, that corresjtonding to the ' vertical line' 

 of Quain, running upwards parallel to the mesial line from the middle of Poupart's 

 ligament, is already familiar to the greater number of observers; but it has the 

 disadvantage of making the mesial regions very large in proportion to the lateral 

 regions, the upper lateral regions being still further reduced in women owing to the 

 narrowness of the chest when compared with the widtli of the pelvis. As an aher- 

 native, the outer border of the rectus would be ]>referable. as it is usually to be 

 locaUsed without difficulty by the lateral infracostal furrow above, and by the 

 pubic spine below; and when these points are indistinct, the breadth of the patient's 

 hand at the head of the metacarpal bones may be taken as equal to the lireadth of 

 the rectus in its upper two-thirds. This jdane. while reducing the width of the 

 middle zone without interfering materially with existing indications of contents, 

 leaves an inguinal region that includes the whole of the inguinal canal. Each plane 

 cuts the kidney, transverse colon, and small intestine, and the ovaries lie at or near 

 its intersection with the lower horizontal (interspinous) plane; the right plane cuts 

 also the gall bladder, iind sometimes the ctecum; the left cuts the sigmoifl flexure, 

 the stomach (great cul-de-sac), the pancreas, and the spleen. The subjoined table 

 will show the contents of the regions adjusted according to this scheme. If the 



