Abdominal surgery . ntery. It is always possible to separate thecollapsing peritoneal folds, even when the bowel is empty, and soreach the bowel without entering the peritoneal cavity. It must benoted that, according to Trevess investigations, there is morelikelihood of a mesentery being found on the left than on theright side. The best practical guide to the site of the bowel is that fur-nished by Allingham, as a result of numerous dissections. Itwill be found directly under a point marked on the skin abouthalf an inch behind the middle of the crest of the ilium, asmeasured between its anteri
Abdominal surgery . ntery. It is always possible to separate thecollapsing peritoneal folds, even when the bowel is empty, and soreach the bowel without entering the peritoneal cavity. It must benoted that, according to Trevess investigations, there is morelikelihood of a mesentery being found on the left than on theright side. The best practical guide to the site of the bowel is that fur-nished by Allingham, as a result of numerous dissections. Itwill be found directly under a point marked on the skin abouthalf an inch behind the middle of the crest of the ilium, asmeasured between its anterior and posterior spmes. It has THE OPERATION. 455 been recommended that this point be marked on the skin in , as a matter of fact, when the muscles have been dividedthe forefinger is the best guide. The obHque incision recommended by Bryant is the chief advantage is, that it gives more room for its lengththan do other incisions. Further claims in its favour are, that ^^^^^ i^., A ^— ^^^^^^^ H ^^ ^l. Fig. 55. {After Braune.) Transverse Section throvgh the Navel to show the parts concerned in Colotomy. I. Umbilicus. 2. Rectus Muscle. 3. Great Omentum. 4. Ureter. 5. TransversalisMuscle. 6. Internal Oblique. 7. Right External Oblique. 8. Ascending Colon, g. QuadratusLumborum. 10. Psoas Muscle. 11. Inferior Vena Cava. 12. Cartilage between 3rd and 4thLumbar Vertebras. 13. Spinous Process of 4th Lumbar Vertebra. 14. Lamina of 3rd LumbarVertebra. 15. Descending Aorta. 16. Psoas. 17. Quadratus Lumborum. 18. DescendingColon. 19. External Oblique. 20. Internal Oblique. 21. Omentum. 22. Ureter. 23. Transverse Colon. it necessitates division of a smaller number of nerves and vesselsthan other methods ; and that it facilitates coaptation by lyingin the line of a natural fold, and helps to prevent prolapse ofthe bowel by lying almost transversely to its axis. In thinpatients, and particularly in women, whose iliac crests are more 456 COLOTOMY. prominent than in m
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