A textbook of medical practice for practitioners and students / edited by William Bain ; with illustrations.
- Date:
- 1904
Licence: In copyright
Credit: A textbook of medical practice for practitioners and students / edited by William Bain ; with illustrations. Source: Wellcome Collection.
Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.
43/1068 (page 15)
![cutaneous nerves. It is usually completely surrounded by peritoneum, and an ulcer per- forating its walls would open into the peritoneal cavity if adhesions had not formed ; occasionally it is attached to the iliacus by a mesentery, and in some rare cases its posterior wall is entirely devoid of peritoneum or it has two mesenteric folds which form the lateral boundaries of a retro-eaecal fossa. On the left side of the upper end of the caecum, at its junction with the ascending colon, is the ileo-cmcal orifice, an antero-posterior cleft, guarded by a valve formed by an upper and a lower cusp, which tends to prevent regurgitation into the small intestine. The vermiform appendix springs from the inner and posterior wall of the crncum about one inch below the ileo-cajcal orifice and it runs upwards and to the left behind the coils of the ileum, or downwards and backwards into the pelvis, or directly upwards behind the cjecum and ascending colon in the occasionally present retro-csecal fossa. The ascending colon passes upwards from the right iliac through the right lumbar to the right hypochondriac region lying in front of the iliacus and quadratus lumborum muscles, and the last dorsal, the ilio hypogastric and the ilio-inguinal nerves. It is usually covered in front by coils of small intestine, but if it is distended it may advance to the anterior abdominal wall. The transverse colon passes from the right hypochondriac region downwards and forwards into the umbilical region and thence upwards and backwards into the left hypo- chondriac region, forming a curve, with the convexity downwards, along the lower part of the stomach. On the right it is under cover <>f the liver and gall bladder, on the left it is separated from the costal cartilages of the ninth ami tenth ribs by the diaphragm, and, as it crosses the umbilical region, it is se|virated from the anterior wall of the abdomen by the great omentum. Behind it, from right to left, lie the second and third parts of the duodenum, the superior mesenteric artery, and coils of small intestine, the latter as a rule separating it from the anterior surface of the left kidney. Its upper border embraces the lower jiart of the stomach and its lower border rests upon the coils of jejunum and ileum. At its right and left extremities respectively are the hej»atic and splenic flexures by which it is connected with the ascending and descending portions of the colon. The hepatic flexure is less acute and less fixed than the splenic flexure, and therefore less likely to prove a source of obstruction. It lies in the right hyjM>chondriac region under cover of the right lobe of the liver which separates it from the cartilages of the ninth and tenth ribs and it is placed in front of the right kidney. The splenic flexure is situated in the left hypochondriac region in contact with the lower end of the spleen and it is attached to the diaphragm, opjMisite the eleventh rib, in the mid-axillary line, by the phrenico-colic fold of peritoneum. The relations of the descending colon are similar to those of the ascending colon except that the upper part of the descending colon overlaps the lower |>artof the anterior surface of the left kidney. I lie ilio-pelvic colon commences in the upper part of the left iliac region and runs downwards and slightly outwards, to the anterior superior spine, behind coils of the small gut. From the anterior superior spine it runs inwards along Poupart’s ligament to the brim of the pelvis, jtassing in front of the anterior crural and external cutaneous nerves and frequently lying immediately behind the anterior abdominal wall, but sometimes being separated from it by a coil of small intestine. After crossing the brim and descending into the cavity of the pelvis it lies on the upper jwirt of the bladder anil, in the female, on the uterus, and then ascends, regaining tne pelvic brim at the commencement of the external iliac artery, whence it jtasses downwards, inwards and backwards to the front of the middle of the sacrum, crossing in front of the left internal iliac artery, the left ureter and the left sacral plexus, all of which may be pressed u|*>n by accumulates! fieces. The upper j>art of this portion of the large intestine has no peritoneum on its ^interior surface, but the remainder is completely surrounded and is attached by a mesentery t<> the posterior walls of the abdomen and pelvis. The portion of the ilio-j>eivic colon which extemls from the iliac fossa into the jielvis and thence liack to the pelvic brim was originally known as the sigmoid flexure, and the remaining part as the first portion of the rectum. The rectum descends from the middle of the sacrum to the apex of the prostate in the male, and to the apex of the perineal body in the female. In the upper half of its extent its anterior and lateral surfaces are covered by peri- toneum, the remaining jiarts are in direct contact with adjacent organs. In l>oth sexes the ]sisterior surface is in relation with the front of the lower jiart of the sacrum, the coccyx and the mass of mixed muscular ami fibrous tissue called the ano-coccygeal body, which tills the interval lietween the tip of the coccyx and the back of t.he anus. The anterior surface is in relation in the male with the l>ase of the bladder, the seminal vesicles and the vasa deferentia intervening, and with the posterior surface of the prostate; whilst in the female it is separated from thu lower part of the uterus by coils of small intestine, and it is bound by loose areolar tissue to the posterior surface of the vagina. I he anal passage is placed at right angles to the rectum, from which it runs down- wards and liackwards to the anal orifice. Its length is alxmt one and a half inch, and](https://iiif.wellcomecollection.org/image/b24974389_0043.jp2/full/800%2C/0/default.jpg)
