So many variations in the order of section of the abdominal organs
are given by different writers that it is impossible to escape
the conclusion that the best order is the one best adapted to the
individual case. A very common order is _spleen_, _left adrenal_
and _kidney_, _right adrenal_ and _kidney_, _duodenum_, _stomach_,
_pancreas_, _liver_, _intestines_, _pelvic organs_ and _genitalia_.
Beneke advises the removal of spleen, then the removal of the
entire intestines, stomach and pancreas, in connection with the
gall-bladder, which is stripped from the liver and removed in
connection with common duct and duodenum, the whole mass removed
from the body and examined outside. Other prosectors begin with the
_liver_, then the _spleen_, _urinary bladder_ and _kidneys_ and
_genital organs_, the _gastro-intestinal tract_ being left to the
last. It may then be opened inside the body without inconvenience
resulting from the escape of its contents into the peritoneal
cavity. After surgical operations when permission for autopsy
is refused, the abdominal, and also the thoracic organs, may be
removed through the laparotomy wound.
After the examination of the abdominal viscera is completed the
=abdominal aorta= is opened in the median line of its anterior wall
and followed into its branches, the iliacs and hypogastrics. When
occasion demands it may be stripped from the spine and opened outside
of the body. The =inferior vena cava= is also opened throughout
its length and followed into its branches. The abdominal portion of
the =thoracic duct= should receive attention before the aorta is
removed. The receptaculum chyli is found by lifting up the right edge
of the aorta at the level of the second or third lumbar vertebra
and dissecting out the duct up to its thoracic portion. It may then
be opened by the fine probe-pointed shears. The =retroperitoneal
lymphnodes= and =haemolymphnodes= are examined _in situ_, or removed
with the blood-vessels and examined outside of the body. The
=sympathetic ganglia=, particularly the _suprarenal_ and the _cœliac
plexuses_, and the _splanchnic nerves_ are to be examined, especially
in cases of Addison’s disease. The section of the abdomen closes
with the examination of the =ileopsoas muscles= and =diaphragm= by
means of longitudinal or transverse incisions, and the inspection of
the =vertebrae=. Pathologic conditions in the latter are examined
according to indications.
II. POINTS TO BE NOTED IN THE EXAMINATION OF THE ABDOMEN.
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