THE SPLEEN 



405 



abdominal wall. But the anterior angle can be palpated while it 

 is still under cover of the ribs by pressing upwards and back- 

 wards during expiration. When it leaves the costal margin, 

 the spleen passes obliquely across the abdomen in direct con- 

 tact with the anterior wall so that it can be both palpated and 

 percussed very easily. The obliquity of the anterior border of 

 a tumour in the left half of the abdomen and the presence 

 upon it of one or more notches is sufficient to justify the 

 diagnosis of splenic enlargement. 



FIG. 144. Transverse Section through the Abdomen at the level of 

 the epiploic foramen (of Winslow), to show the disposition of 

 the peritoneum and the connexions of the spleen. 



In this section the stomach is cut along the line A (Fig. 89). 



I. Stomach. 



II. Epiploic foramen. 

 IV. Right kidney. 



V. Left kidney. 

 VI. Spleen. 



VII. Omental bursa (lesser 

 sac). 



2. Lieno-renal ligament. 



3. Gastro - splenic liga- 



ment. 



4. Aorta. 



5. Hepatic artery. 



6. Portal vein. 



7. Inferior vena cava. 



8. Bile duct. 



The dulness produced by an enlarged spleen may merge 

 with the liver dulness, but a A-shaped notch can usually be 

 demonstrated between the two viscera. 



In rupture of the spleen it is usually the diaphragmatic 

 surface which is involved, and the haemorrhage occurs 

 directly into the greater peritoneal sac (Fig. 144). 



The spleen obtains its blood-supply from the splenic artery, 

 which is one of the branches of the coeliac artery. The 



