352 SURGICAL APPLIED AK ATOMY. [Chap. xvn. 



having been divided, the loop of the sigmoid flexure is 

 brought into the wound, is secured, and is (probably 

 at a later period) opened. 



The caecum may be opened upon the right side, 

 and as a rule the most convenient incision is an oblique 

 one placed external to the deep epigastric artery. 



Colectoniy consists in resecting a portion of either 

 the ascending or descending colon that is the seat of a 

 carcinomatous or other stricture. It is most con- 

 veniently performed in the lumbar region, and then 

 involves the formation of an ai'tificial anus that will 

 probably be permanent. Colectomy may, however, be 

 carried out thi-ough an incision in the middle line, and 

 may concern the transverse colon ; in such a case the 

 ends of the divided bowel are united, and the abdomi- 

 nal wound closed.* Lumbar colectomy may be per- 

 formed through the incision pi-actisecl in colotorny. 



The liver. The liver is moulded to the arch of the 

 diaphragm, and lies over a part of the stomach (Fig. 

 34). The convex surface is protected on the right side 

 by the ribs, from the seventh to the eleventh inclusive, 

 and in front by the xiphoid cartilage and the costae 

 from the sixth to the ninth inclusive, the diaphragm 

 being interposed. The diaphragm separates the liver 

 from the thin margin of the base of the right lung, 

 which descends in front of it. It extends to the left 

 about one and a half inches beyond the left margin of 

 the sternum. In the middle line the liver lies close 

 beneath the skin in front of the stomach, and reaches 

 about half way between the xiphoid cartilage and the 

 navel. The lower edge, ag it crosses the subcostal angle, 

 is represented by a line drawn from the ninth right 

 to the eighth left costal cartilage (Fig. 30). In. the 

 erect posture the lower edge on the right side is 

 about half or quarter of an inch below the margins of the 



* See "Resection of Portions of Intestine," bj the Author. 

 Trans. Royal Mecl.-Chir. Soc., 1882. 



