Henry Gray (18251861). Anatomy of the Human Body. 1918.
are also behind it. At its medial side is the head of the pancreas, and the common bile duct; to its lateral side is the right colic flexure. The common bile duct and the pancreatic duct together perforate the medial side of this portion of the intestine obliquely (Figs. 1057 and 1100), some 7 to 10 cm. below the pylorus; the accessory pancreatic duct sometimes pierces it about 2 cm. above and slightly in front of these.
The horizontal portion (pars horizontalis; third or preaortic or transverse portion) is from 5 to 7.5 cm. long. It begins at the right side of the upper border of the fourth lumbar vertebra and passes from right to left, with a slight inclination upward, in front of the great vessels and crura of the diaphragm, and ends in the ascending portion in front of the abdominal aorta. It is crossed by the superior mesenteric vessels and the mesentery. Its front surface is covered by peritoneum, except near the middle line, where it is crossed by the superior mesenteric vessels. Its posterior surface is uncovered by peritoneum, except toward its left extremity, where the posterior layer of the mesentery may sometimes be found covering it to a variable extent. This surface rests upon the right crus of the diaphragm, the inferior vena cava, and the aorta. The upper surface is in relation with the head of the pancreas.
The ascending portion (pars ascendens; fourth portion) of the duodenum is about 2.5 cm long. It ascends on the left side of the aorta, as far as the level of the upper border of the second lumbar vertebra, where it turns abruptly forward to become the jejunum, forming the duodenojejunal flexure. It lies in front of the left Psoas major and left renal vessels, and is covered in front, and partly at the sides, by peritoneum continuous with the left portion of the mesentery.
The superior part of the duodenum, as stated above, is somewhat movable, but the rest is practically fixed, and is bound down to neighboring viscera and the posterior abdominal wall by the peritoneum. In addition to this, the ascending part of the duodenum and the duodenojejunal flexure are fixed by a structure to which the name of Musculus suspensorius duodeni has been given. This structure commences in the connective tissue around the celiac artery and left crus of the diaphragm, and passes downward to be inserted into the superior border of the duodenojejunal curve and a part of the ascending duodenum, and from this it is continued into the mesentery. It possesses, according to Treitz, plain muscular fibers mixed with the fibrous tissue of which it is principally made up. It is of little importance as a muscle, but acts as a suspensory ligament.
Vessels and Nerves.The arteries supplying the duodenum are the right gastric and superior pancreaticoduodenal branches of the hepatic, and the inferior pancreaticoduodenal branch of the superior mesenteric. The veins end in the lienal and superior mesenteric. The nerves are derived from the cliac plexus.
Jejunum and Ileum.The remainder of the small intestine from the end of the duodenum is named jejunum and ileum; the former term being given to the upper two-fifths and the latter to the lower three-fifths. There is no morphological line of distinction between the two, and the division is arbitrary; but at the same time the character of the intestine gradually undergoes a change from the commencement of the jejunum to the end of the ileum, so that a portion of the bowel taken from these two situations would present characteristic and marked differences. These are briefly as follows:
The Jejunum (intestinum jejunum) is wider, its diameter being about 4 cm., and is thicker, more vascular, and of a deeper color than the ileum, so that a given length weighs more. The circular folds (valvulæ conniventes) of its mucous membrane are large and thickly set, and its villi are larger than in the ileum. The aggregated lymph nodules are almost absent in the upper part of the jejunum, and in the lower part are less frequently found than in the ileum, and are smaller and tend to assume a circular form. By grasping the jejunum between the finger and thumb the circular folds can be felt through the walls of the gut; these being absent in