344 SURGICAL APPLIED ANATOMY, ia-.ap.xvu. 



may become perforated. Troubles in the vermiform 

 process are the most frequent causes of typhlitis or 

 perityphlitis. These terms are applied to localised 

 inflammation of the peritoneum in the vicinity of the 

 csecum. 



It is in the ileo-csecal region that intussusception 

 most frequently occurs. In this condition one part of 

 the intestine is prolapsed or " telescoped " into the 

 lumen of an immediately adjoining part. In the ileo- 

 csecal vaiiety (the commonest form) the narrow ileurn, 

 and subsequently the caecum, are prolapsed into the 

 colon. The ileo-caecal valve forms the summit of the 

 protrusion or intussusceptum. By a gradual increase 

 of the condition the intussuscepted bowel may at last 

 reach the rectum, and the ileo-caecal valve has, in fact, 

 been recognised protruding from the anus. In the 

 ileo-colic variety (the rare form) the end of the ileuin 

 is prolapsed through the valve. The valve and the 

 caecum remain in their normal situations, and the 

 summit of the intussusceptum is formed only by the 

 ileum. 



The large intestine. From the caecum to the 

 sigmoid flexure, this portion of the bowel is accessible 

 to pressure except at the hepatic and splenic flexures, 

 which are deeply placed. The hepatic flexure is 

 under the shadow of the liver, and the splenic curve, 

 which reaches a higher level, is behind the stomach. 

 The position of the transverse colon can often be well 

 marked out. It crosses the belly transversely, so that 

 its lower border is on a level with the umbilicus (Fig. 

 30). In cases of faecal accumulation, the outline of the 

 colon, with the exception of the two flexures above 

 named, may be distinctly defined. In distension of the 

 small intestine the belly tends to present the greatest 

 degree of swelling in front, and about and below 

 the navel. In distension of the Im-ger gut, the front 

 of the abdomen may remain (for a while at lease) 



