18 Dr Barclay-Smith, Extreme Visceral Dislocation. 



A case of extreme visceral dislocation : with remarks on the 

 functional interpretation of the agminated glands of the intestine. 

 By E. Barclay-Smith, M.D., King's College; Senior Demon- 

 strator in Anatomy, 



[Bead 27 October 1902.] 



The case under notice is remarkable for the enormous dis- 

 placement of some of the larger and more important abdominal 

 viscera as a result of a distension of the proximal segment of the 

 large intestine. 



The ascending colon and the right end of the transverse colon 

 were involved in an enormously distended coil which had in- 

 sinuated itself upwards on the right side of the abdominal cavity, 

 gaining an extensive area of contact with the diaphragm. 



The viscera which had suffered the greatest displacement as 

 the result of this colic enlargement were the right kidney, the 

 liver, and the stomach. 



The right kidney was displaced upwards. The displacement 

 was not a very serious one, but was sufficient to place the right 

 kidney at a level considerably higher than that of the left, and 

 to impose an upward obliquity on the right renal vessels, i.e. an 

 obliquity which is the converse of the normal disposition of these 

 vessels. 



The liver had undergone what at first sight seemed an almost 

 complete transposition. When viewed from in front, a considerable 

 portion of the right lobe was disposed to the left of the mesial line, 

 and the fundus of the gall bladder had acquired a relation to the 

 left infracostal margin, nearly complemental to its usual position 

 on the right side of the body. A closer examination however 

 elucidated the fact, that the hepatic displacement was not due 

 so much to a direct transposition, as to an irregular torsion of 

 such a kind as to effect a very considerable displacement leftwards 

 of the fore-part of the liver, while the hinder-part had suffered in 

 this respect to a very much lesser degree. In other words, the 

 liver had undergone a considerable amount of distortion, the fore- 

 part having felt the effect of the colic distension to a very much 

 greater extent than the hinder. 



The stomach was almost completely on the left side of the 

 vertebral column, and this in spite of the fact that it exhibited a 



