Fig. 130. Position of the Viscera which lie outside the Peritoneum. 



Woman aged yO. The Intestines have been removed from the Cardiac end of 

 the Stomach down to the Rectum. Pancreas and Spleen in normal position. 

 Parietal peritoneum lias been removed in the Abdominal but left in the Pelvic 



Cavity. 



The Peritoneal Cavity has been opened in the following way. The median 

 incision extends from the Xiphoid to the left side of the Umbilicus below which 

 part the incisions diverge towards the right and left Anterior Superior Iliac 

 Spines. The two large upper flaps are further divided into two smaller ones by 

 incisions running towards the loth ribs. 



The two Kidneys (practically at the same level, though the left is usually 

 ihe higher, cf. Fig. 125) together with their large arteries from the Aorta are 

 shewn with their veins which enter into the Inferior Vena Cava. At the hilum 

 the Vein is situated in front of the Artery, which has divided into many branches, 

 whereas the Ureter is situated behind. 



The left Renal Vein passes in front of the Aorta to join the Inferior Vena 

 ("ava; the termination of this left renal vein and the right vessels are covered by 

 the head of the Pancreas. 



The Pancreas extends across at the level of the ist Lumbar \'ertebra 

 from the Right Kidney to the Left, terminating in relation with the Spleen and 

 lying in front of the Aorta and Inferior Vena Cava. 



Above the Pancreas the Coeliac Axis with its three diverging branches is 

 shewn ; below the Superior Mesenteric Artery, (the origin of which lies under cover 

 of the gland), at a lower level and to the right is the Middle Colic Artery. To the 

 right of this Artery is the Superior Mesenteric \"ein whereas further to the left 

 is the Inferior Mesenteric Vein. Above the Pancreas the Portal Vein can be seen, 

 cut off at the hilum of the Liver. This vein is fonned by the union of the 

 Splenic and the Superior Mesenteric Veins. 



The Ureters passing downwards on the Psoas Muscles cross the Iliac 

 Vessels — on the left ^/j inch above, on the right Vi inch below the origin of the 

 Internal Iliac Arterj^ — and course along the outer wall of the true pelvis to the 

 Trigone of the Bladder. In the Male the Ureter crosses the Vas Deferens, passing 

 below this duct; in the Female the Ureter passes below the Uterine ^\rtery. 



To the right of the A<irta lies the Inferiiir Vena Cava, between these 

 large vessels and to the left of the Aorta are large lymphatic glands. 



The Aorta bifurcates into the Common Iliac Arteries at the lower border 

 of the 4th Lumbar Vertebra. 



The inlet of the true pelvis is almost completelv filled up by the much 

 distended Rectum (ligatured) and the Uterus (in this instance enlarged) which 

 overUes the Bladder. (Cf. Figs. 146 and 147.) 



