TOPOGRAPHY OF THE THORAX AND ABDOMEN 



45 



it may be located a little internal to the right tenth costal 

 cartilage. It is anterior and external to the hilus of the 

 kidney. It lies between the right lobe of the liver extern- 

 ally and the descending duodenum internally. The right 

 lobe of the liver lies above the flexure while the fundus of 

 the gall bladder is about 1 cm. above and in front of its 

 highest point. 



Quain" locates the hepatic flexure at the level of the 

 first lumbar while Hermann and RuedeP locate it as low 

 as the upper part of the third lumbar vertebra. 



The transverse colon is also distended near its begin- 

 ning but the part lying to the left of the midline is con- 

 tracted. At the hepatic flexure the colon turns forward, 

 downward and to the left. The downward turn is small so 

 that the colon soon takes a direction upward, backward and 

 to the left (Plates XXVIII and XXXII) to reach the infer- 

 ior pole of the spleen. The highest point reached by the 

 colon is at the level of the upper border of the twelfth 

 thoracic vertebra about 5 cm. to the left of the midplane and 

 about 5 cm. in front of the midaxillary plane. From this 

 highest point the colon descends rapidly, crosses the mid- 

 axillary plane at the level of the first lumbar vertebra and 

 comes into contact with the lower end of the spleen (Plates 

 XVI, XXVIII, XXIX, XXXI, XXXII, XXXIII and XXXV). 

 This part of the colon is peritonaeal and is attached to the 

 body wall by a mesocolon which arises from the anterior 

 surface of the second portion of the duodenum and the 

 head and anterior border of the pancreas. It is bound 

 more or less closely to the greater curvature of the 



'Thane, G. D. and Godlee, R. J., Quain's elements of anatomy. 

 Appendix. Superficial and surgical anatomy. London, 1S96. 

 »Loc. cit. 



