324 SURGICAL APPLIED ANATOMY. rChap.xvn. 



the bowels together and forming spaces between them. 

 In perforation of the bowel from disease, an opportune 

 adhesion of the omentum over the aperture may 

 prevent escape of the intestinal contents. 



Large masses of tissue may be nourished through 

 an adherent omentum. Thus when the proper blood 

 supply of an ovarian tumour has been cut off by 

 twisting of its pedicle, the growth may be nourished 

 through the omentum, if that structure is adherent to 

 it. In hernise the omentum generally contracts adhe- 

 sions to the sac, and becomes irreducible, or it may 

 form a kind of second sac about the gut itself ("omen- 

 tal sac "). The end of the omentum, by becoming 

 adherent to distant parts, as to the pelvic viscera, may 

 form itself into a firmly attached band, beneath which 

 the bowel may be fatally strangled. In like manner 

 the intestine has been strangulated through slits and 

 holes that have developed in the omentum, usually as 

 a result of inflammatory adhesions. When the great 

 omentum contains much fat it must act as an excellent 

 protection to the bowels, and must, as a layer of non- 

 conducting material, help to maintain the equality of 

 their temperature. 



The mesentery. The parietal attachment of the 

 mesentery is liable to some variation. The point at 

 which this attachment commences above is practically 

 constant. It corresponds with the ending of the duo- 

 denum, is about on a level with the lower border of the 

 pancreas, and is just to the left of the second lumbar 

 vertebra. (See page 338.) From this point the 

 insertion of the mesentery follows an oblique line that 

 runs downwards and to the right, crossing the great 

 vessels, and then ending in a somewhat uncertain 

 manner on the right iliac fossa. Its right or upper 

 layer is continuous with the under layer of the trans- 

 verse meso-colon, and with the peritoneum that invests 

 the ascending colon. Its left or lower layer joins with 



