340 SURGICAL APPLIED ANATOMY. [Chap. xvn. 



inouth of which is the orifice of the fossa duodeno- 

 jejunalis. 



In the meso-colic hernia of Cooper the small in- 

 testine is found also in a retro-peritoneal sac. This 

 sac, however, is to the left of the middle line, and is 

 developed at the expense of the peritoneum leading to 

 the descending colon. It has nothing to do with the 

 fossa just described, but is due to the enlargement of 

 a deep pouch that I have described as occasionally 

 existing in the parietal peritoneum leading to the 

 descending colon. The mouth of the pouch is directed 

 upwards, and is skirted by a branch of the inferior 

 mesenteric artery. 



Liaparotomy. In this procedure the abdomen is 

 opened from in front for the purpose of exploration, 

 or for the relief of a piece of bowel strangulated by a 

 band, and under certain other circumstances. It much 

 more frequently concerns the small bowel than the 

 large. The incision is usually made in the middle 

 line below the umbilicus, and a cut from three to 

 four inches long is usually found to be sufficient. It 

 may be made in either of the semilunar lines or 

 over any spot especially indicated by the disease. 

 Enterotomy is the operation of opening the small in- 

 testine above some obstruction that threatens to be 

 fatal or insuperable. The incision is made in the 

 linea alba, below the umbilicus, or in one or other 

 iliac region, as is considered more convenient. An 

 incision some three inches in length will probably 

 suffice. The peritoneum having been opened, a 

 knuckle of small bowel close above the obstruction is 

 seized, is secured to the parietal wound, and then 

 opened. The small intestine has also been opened to 

 remove impacted foreign bodies and large gall stones. 

 In such cases the intestinal wound is closed imme- 

 diately. Enterectomy. Portions of the small intes- 

 tine have been resected with success for various 



