18. A wound to the posterior left axillary line, between the ninth and tenth rib, and extending approximately 5 cm deep, will most likely damage

A. Ascending colon B. Duodenum

C. Left kidney D. Spleen

ANS. D.

The spleen follows the long axes of ribs 9 to 11 and lies mostly posterior to the stomach, above the colon, and partly anterior to the kidney. It is attached to the stomach by a broad mesenterial band, the gastrosplemic ligament. Therefore, it is the most likely organ of the group to be pierced by a sharp object penetrating just above rib 10 at the posterior axillary line. Note that the pleural cavity, and possibly the lower part of the inferior lobe of the lung, would be pierced before the spleen. The ascending colon (choice A) is on the wrong side (the right) to be penetrated by a sharp instrument piercing the left side. Most of the duodenum (choice B) is positioned too far to the right to be affected by this injury. Even the third part of the duodenum, which runs from right to left, would still be out of harm's way. In addition, the duodenum lies at about levels L1 to L3, placing it too low to be injured in this case. The superior pole of the left kidney (choice C) is bordered by the lower part of the spleen. However, it is crossed by rib 12 and usually does not extend above rib 11. It would probably be too low and medial to be injured in this case because this penetration is at the posterior axillary line.

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