Acute abdominal diseases : including abdominal injuries and the complications of external hernia / by Joseph E. Adams and Maurice A. Cassidy.

  • Adams, Joseph E. (Joseph Ebenezer), 1878-
Date:
1913
Catalogue details

Licence: Public Domain Mark

Credit: Acute abdominal diseases : including abdominal injuries and the complications of external hernia / by Joseph E. Adams and Maurice A. Cassidy. Source: Wellcome Collection.

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    transpyloric plane, and about an inch and a half to the left of the median vertical plane. Behind the commence- ment of this part of the duodenum 1s the right ureter. The Duodeno-Jejunal Flexure is the most fixed part of the small bowel, and is a most important surgical land- mark. It marks the commencement of the small intestine proper, and may be located, after the abdomen is opened, by one or other of the following methods : (a) if the omentum _ and transverse colon be turned upwards and pulled out through the wound towards the right side of the abdomen the: posterior layer of the transverse meso-colon will be exposed to view, and passing from it on the left side of the second lumbar vertebra will be seen a more or less vertical fold of peritoneum, termed the meso-colic band, which passes on to the first part of the jejunum. Traction on the trans- verse meso-colon as a rule tightens this band and brings the’ commencement of the jejunum readily into view. It is probable that this fold, which appears to be constantly present, though of variable size and direction, has for its function the maintenance of a free passage through the duodeno-jejunal flexure by preventing kinking of the jejunum, which tends to fall to the right or left according as the patient lies on his right or left side. If this band be identified the surgeon may be quite sure that the bowel to which it leads is the first part of the jejunum; (0) if the hand be passed through the laparotomy wound on the deep aspect of the abdominal wall to the left flank, and further, till the surface of the left kidney is reached, then when the hand is brought forward it should grasp a piece of small bowel, and this, from its fixity, may be identified as the commencement of the jejunum. The former method is undoubtedly the better, and is applicable in all cases where the surgeon is operating through an upper abdominal incision ; where there is need for such identification through a lower abdominal wound the second method will be found reliable. It may | also be noted that the wall of the first part of the jeyunum is thicker than that of the remainder of the small intestine,