Surgery of the upper abdomen / by John B. Deaver and Astley Paston Cooper Ashhurst.

  • John Blair Deaver
Date:
[1921]
Catalogue details

Licence: Public Domain Mark

Credit: Surgery of the upper abdomen / by John B. Deaver and Astley Paston Cooper Ashhurst. Source: Wellcome Collection.

    30/872 page 6
    to the position of the pyloric orifice, the line of the greater curvature is convex downward and to the left; that of the lesser curvature is nearly vertical when the stomach is empty. The duodenum is from 25 to 30 cm. in length, commencing at the pvloric orifice of the stomach, and ending in the jejunum at the left side of the body of the second lumbar vertebra, after having described a half circle with its convexity downward. The first portion of the duodenum, about 5 cm. long, passes from the pyloric end of the stomach to the right, upward and backward, to the neck of the gall-bladder; the second portion is about 8 cm. in length, and extends from the neck of the gall-bladder, downward along the right of the spinal column to the level of the third lumbar vertebra. Here the third portion of the duodenum commences, passing obliquely upward to the left, across the body of the second lumbar vertebra. A line drawn from a point 8 cm. to the right of the umbilicus, to a point 5 cm. to the left and above it, will nearly indicate the position of the third portion. The fourth portion is only about 2 cm. in length; it passes upward from the termination of the third portion, and becomes continuous with the jejunum at the origin of the mesentery. The pancreas extends across the bodies of the first and second JL lumbar vertebrae from the hilum of the spleen in the left hypochondriac region, to the second portion of the duodenum in the epigastric region. Its length is from 15 to 20 cm., and its largest portion, called the head, is surrounded by the semicircle of the duodenum as a picture is surrounded by its frame; while its body crosses the spinal column, and its tail is in contact with the spleen. It lies between the celiac axis, above, and the superior mesenteric vessels, below, these latter separating it from the transverse (third) portion of the duodenum. The spleen extends in the mid-axillary line longitudinally from the ninth to the eleventh rib, and transversely from the midaxillary to the posterior axillary line. Its long axis is nearly parallel to the course of the ribs. Embryology.—To understand the various folds and recesses of the peritoneum in the upper abdomen it is essential to revert to the embryonal stage before this membrane has developed the perplexing conditions found in adult life. For practical purposes it is sufficient to describe the fetal state as follows: The peritoneum is to be regarded as a closed sac filling the abdominal cavity; along the posterior part of the abdominal cavity, back of this closed sac and parallel with the spinal column, runs the digestive tract in the form of a long straight tube. At first this tube is in connection with the region outside of the
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