45 ABDOMEN 



of the lesser omentum. First cut through the posterior layer along the left 

 border of the hepatic artery, then carry the incision upwards along the 

 margin of the fossa for the ductus venosus. Finally cut through the 

 posterior layer for a short distance along the lesser curvature of the stomach, 

 above the left gastric artery, and turn the separated portion of the posterior 

 layer of the lesser omentum to the left over the stomach. Again introduce 

 the hand from the lower part into the upper part of the omental bursa and 

 examine again the constriction of the cavity between the cesophageal and 

 pyloric ends of the stomach and the pancreatico-gastric folds which cause it. 

 It is not possible to make a thorough examination of the cavity of the 

 omental bursa till the stomach, which lies in its anterior wall, has been 

 turned aside. Divide the right gastric artery and the right gastro-epiploic 

 artery immediately to the left of the pylorus, then cut through the stomach 

 in the same situation and turn it over to the left side. The greater part of 

 the anterior wall of the omental bursa is now removed, and the cavity and 

 the remaining boundaries can be examined. 



The Cavity of the Omental Bursa extends from the lower 

 margin of the greater omentum below to the liver above, and 

 a narrow, pouch-like recess is prolonged upwards, behind the 

 liver, to the under surface of the diaphragm. The posterior 

 wall of the sac is formed from below upwards by the two 

 posterior layers of the great omentum, the transverse colon, 

 covered by peritoneum, the transverse meso-colon, and, above 

 the line of attachment of the transverse meso-colon to the 

 posterior abdominal wall, by the upper of the two layers of the 

 transverse meso-colon, the so-called "ascending layer," which 

 passes upwards, in front of the pancreas, the upper and medial 

 part of the left kidney, the left suprarenal gland and the crura 

 of the diaphragm, to the under surface of the diaphragm from 

 which it is reflected forwards to the upper part of the posterior 

 surface of the liver. The outline of the pancreas can be seen 

 through the thin peritoneum and the kidney, and the supra- 

 renal glands, if not visible, are easily felt. 



The narrow, pouch-like upper portion of the cavity of the 

 omental bursa is bounded behind, as already stated, by the 

 peritoneum on the abdominal surface of the crura of the 

 diaphragm; above by the reflection of the peritoneum forwards 

 to the posterior surface of the liver ; in front by 'the peritoneum 

 on the posterior surface of a small subdivision of the posterior 

 aspect of the right lobe of the liver called the caudate lobe (O.T. 

 Spigelian) ; on the left by the reflection of the posterior layer 

 of the small omentum from the margin of the fossa for the 

 ductus venosus to the crura of the diaphragm ; and to the right 

 by the reflection of the peritoneum from the right crus of the 

 diaphragm to the right lateral margin of the caudate lobe. 



