. On retro-peritoneal hernia . it there could be no hernia. I shall presently showthat this view is not universally applicable. Toldt suggested that a fossa which on one occasion hesaw at the right of the transverse mesocolon, near its junc-tion with the ascending mesocolon, might be a dislocatedpouch of Treitz. I have elsewhere remarked that what hesaw was very probably that very rare fossa, the fossa ofBrosike, the recessus inter-mesocolicus transversus. Conditions Predisposing to the Hernia.—The factors whichare, so far as I have been able to ascertain, invariablypresent in c
. On retro-peritoneal hernia . it there could be no hernia. I shall presently showthat this view is not universally applicable. Toldt suggested that a fossa which on one occasion hesaw at the right of the transverse mesocolon, near its junc-tion with the ascending mesocolon, might be a dislocatedpouch of Treitz. I have elsewhere remarked that what hesaw was very probably that very rare fossa, the fossa ofBrosike, the recessus inter-mesocolicus transversus. Conditions Predisposing to the Hernia.—The factors whichare, so far as I have been able to ascertain, invariablypresent in cases of right duodenal hernia are : CONDITIONS PREDISPOSING 59 1. The hernial sac occupies—at any rate, at first—theright half of the abdominal cavity, lying behind the ascend-ing and transverse mesocolon. 2. The orifice is situated behind and to the left of the sac,on the lumbar vertebrae. 3. In the anterior margin of the sac there lies either thesuperior mesenteric artery or a continuation of it, the ileo-colic Fig. 18. — Right Duodenal sac is surrounded by the colon. The Neck of the Sac, etc.—Now, I have already shown thatin exactly the situation where the hernial sac first begins itsdevelopment there is not infrequently in embryos, and occa-sionally in adult life, a fossa situated in the mesentery of theupper part of the mcso-jejunum. This fossa was first described 6o THE DUODENAL FOLDS AND FOSS^ by Waldeyer, but his description has since been persistentlyoverlooked. I propose to call the pouch the fossa ofWaldeyer. This fossa lies within the concavity of the archformed by the superior mesenteric artery; its orifice looks tothe left, its fundus to the right and downwards. Behind itare the lumbar vertebrae covered by peritoneum. Any intes-tine entering this pouch would develop a hernia fulfilling allthe requirements of a right duodenal hernia. As it enlarges
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