THE URETER 



1381 



the right side. The liver, and stomach above, the body of the pancreas and spleen 

 over the centre, and the descending colon over the lower part of the left kidney. 



The attachments of the specialised fibrous sheets known as the renal fascia 

 are shown in figs. 1110 and 1111. 



The anterior and posterior layers are seen to be continuous above and laterally. Medially 

 and below they remain separate and it is in this direction that the abnormally movable kidney 

 travels. The fatty tissue between the kidney and the renal fascia is known as the perinephric 

 fat; that outside the fascia is the paranephric fat. 



The kidneys are maintained in position by (1) the vascular pedicle; (2) fatty 

 capsule and fascia; (3) above all by the intra-abdominal pressure. 



Failure to ascend during development from its original position near the pelvic brim to 

 its normal level accounts for certain cases of movable kidney of congenital origin. In these cases. 



Fig. 1112. — The Abdominal Aorta and Vena Cava Inferior. 



Left lobe of liver 



(Esophagus 



Left phrenic artery 



Right phrenic artery 



Superior suprarenal 

 Left gastric artery 

 Inferior suprarenal 

 Splenic artery 



. Left phrenic vein 

 Left suprarenal vein 



|_^ Superior mesenteric 



artery 

 Tgj- Kidney 



Ureteric branch of renal 

 Left spermatic vein 



Gall-bladder ' W^ " 



Hepatic duct 



Cystic duct 



common bile duct 



Portal vein — 



Gastro-duodenal br 



Right gastric art. 



Hepatic artery 



Right suprarenal vein 



Inferior suprarenal 

 artery 



Renal artery 

 Renal vein 



Inferior vena cava 

 Kidney 



Right spermatic vein 



Right spermatic artery 



Quadratus lumborum 

 muscle 



Lumbar artery 

 and vein 

 Uieteric branch of — 

 spermatic artery 



Middle sacral vessels 



Ureter 



Left spermatic artery 



Inferior mesenteric 

 artery 



iJllll Ureteric branch of 



spermatic 



Ureteric branch of 



common iliac 

 Common iliac artery 



External iliac artery 

 -Hypogastric artery 



the renal artery may take origin from the common iliac artery. An accessory renal artery 

 running into the lower end of the kidney from the aorta may cause kinking of the ureter and is 

 a not uncommon cause of hydronephrosis. 



The suprarenal glands are not so firmly attached to the kidneys as to the 

 diaphragm ; hence they are not encountered in operations for movable kidney and 

 are not removed in nephrectomy. 



Brodel has shown that incisions into the kidney should be made rather behind its convex 

 border (Brodel's bloodless line). Occasionally fusion of the lower poles occurs during develop- 

 ment across the middle Une of the body, and a single horseshoe kidney results, with double 

 ureter and vascular supply. 



The ureter. — On an average 30 cm. (12 in), long, this tube descends almost 

 vertically in its abdominal course on the psoas muscle. It is crossed obliquely 



