Transposition of the Abdominal Viscera.

Abstract

IN an adult female subject brought into the dissecting room of the Medical College, Calcutta, during the winter term of 1928-4, transposition of some of the abdominal viscera was noticed. As such cases are comparatively rare and as pathological conditions of these transposed organs during life are apt to mislead the clinicians, I am publishing a short account of the peculiarities noted.Gastro-intestinal Tract. The size of the stomach is small, being 71 inches in length and 2j inches in breadth. The cardiac orifice is situated at the level of the 11th thoracic vertebra on its right side. The left vagus nerve lies in front of and the right vagus nerve behind the cardiac orifice. The pyloric orifice is situated on the left side of the body of the 12th thoracic vertebra. The lesser curvature extending from the left margin of the oesophagus has the concavity directed upwards and to the left and gives attachment to the hepato-gastric ligament. The greater curvature extending from the right margin of the oesophagus is directed at first upwards and to the right, then downwards and forwards and finally downwards and to the left. The antero-superior surface of the stomach is in relation with the inferior surface of the right lobe of the liver, the gall bladder, the quadrate lobe of the liver and the anterior abdominal wall. The antrum cardiacum of the oesophagus grooves the posterior surface of the right lobe of the liver to the left of the fossa for the inferior vena cava. Duodenum. The duodenum is horseshoe-shaped, with the convexity directed to the left. It is 4 inches in length and situated to the left side of the vertebral column, extending from the left side of the 12th thoracic vertebra to the left side of the body of the 2nd lumbar vertebra. The concavity of the duodenal curve embraces the head of the lower pancreas. The bile duct and the pancreatic ducts open separately on the postero-medial aspect ofthe duodenum, the opening of the bile duct lying half an inch lateral to the opening of the lower pancreatic duct. The hepato-duodenal ligament is attached to the commencement of the duodenum.Jejunum and Ileum. The coils of the jejunum and the ileum are chiefly placed on the left side of the abdominal cavity. They measure only 9 feet in length.Caecum. The caecum is situated in the lower part of the umbilical region on the right side of the middle line.Ascending Colon. The ascending colon, 7 inches in length, passes upward and slightly lateralwards towards the spleen, lying in front of the upper limb