Sequence and methods of clinical assessment of lung auscultation data. Palpation of the sigmoid colon Deep palpation of the intestine

The cecum is located in the right iliac region and has a somewhat oblique direction: from right to top down to left.

In women, the lower border of the cecum coincides with the upper border of the iliac region (interspinous line); in men, it is located slightly lower. However, often the cecum is significantly higher than the normal level. The cecum is located on the border of the middle and outer thirds of the right umbilical-spinous line (linea umbilico-iliac dextra - a conditional line connecting the upper spine of the right ilium with the navel). The right hand is placed flat on the stomach so that the back surface of the fingers is facing the navel, the line of the middle finger coincides with the right umbilical-spinous line, and the line of the tips of the II-V fingers intersects the umbilical-spinous line approximately in its middle. Touching the skin of the abdomen with the fingertips, the examiner moves the hand towards the navel. In this case, a skin fold forms in front of the nail surface of the fingers. At the same time, the patient is asked to inhale with his stomach. After this, the patient is asked to exhale and the fingers of the right hand are immersed deep into the abdominal cavity until the fingertips touch the posterior abdominal wall. At the end of exhalation, the fingertips slide along the posterior abdominal wall towards the iliac spine and at the same time roll over the cecum. At the moment of rolling, the diameter, consistency, surface, mobility, pain of the intestine and the phenomenon of rumbling are determined (Fig. 69).

Fig.69. Palpation of the cecum (top view).

In a healthy person, the cecum is palpated in the form of a painless cylinder of soft-elastic consistency, 3-4 cm wide, has moderate mobility and usually rumbles under the hand.

Palpation of the terminal ileum. The terminal ileum is located in the right ileal region (oblique direction from left to bottom to right to top) and flows from the inside at an acute angle into the cecum (45°). The right (palpating) hand is placed flat on the stomach so that the line of the fingertips coincides with the projection of the intestine. Touching the skin of the abdomen with your fingertips, the examiner moves the hand towards the navel. In this case, a skin fold forms in front of the nail surface of the fingers. After this, the patient is asked to exhale and, using the relaxation of the anterior abdominal wall, immerse the fingers of the right hand vertically deep into the abdominal cavity until the fingertips touch the posterior abdominal wall. At the end of exhalation, the fingertips slide along the posterior abdominal wall in an oblique direction from top left to bottom to right. At the moment of rolling, the diameter, consistency, surface, mobility, pain of the intestine and the phenomenon of rumbling should be determined.

The final part of the ileum can be palpated for 10-12 cm. If the intestine is contracted or filled with dense contents, a sensation of rolling through a smooth, dense cylinder, as thick as the little finger, is created. If the intestinal wall is relaxed and the contents are liquid, then a thin-walled tube is felt, palpation of which causes a loud rumbling.

Palpation of the transverse colon.

Before palpating the transverse colon, it is necessary to find the greater curvature of the stomach. For this purpose, the following methods are used.

Percussion palpation method. Using the ulnar edge of the straightened left hand, placed transversely to the axis of the body, the doctor presses the anterior abdominal wall at the place where the rectus abdominis muscles attach to the chest wall. The right (palpating) hand is placed flat on the stomach (the direction of the hand is longitudinal to the axis of the body, the fingers are closed and facing the epigastric region, the fingertips are at the level of the lower border of the liver, the middle finger is on the midline). The examiner, by abruptly, quickly bending the II-IV fingers of the right hand, without lifting them from the front surface of the abdominal wall, makes jerking blows. If there is a significant amount of liquid in the stomach, a splashing sound is produced. By moving the palpating hand down by 2-3 cm and making similar movements, the examination is continued until the level when the splashing noise has disappeared; this level represents the border of the greater curvature of the stomach.

Ausculto-percussion method. The examiner, with his left hand, places a stethoscope (phonendoscope) on the anterior abdominal wall under the edge of the left costal arch on the rectus abdominis muscle, with the tip of the index finger of his right hand he applies jerky, but not strong blows to the inner edge of the left rectus abdominis muscle, gradually going down from top to bottom. Listening to percussion sounds above the stomach with a stethoscope (phonendoscope), mark the border between the transition of a loud tympanic sound to a dull one. The zone of change in percussion sound will correspond to the border of the greater curvature of the stomach.

Ausculto-affriction method. This method differs from the previous one only in that instead of striking with the fingertip, dashed, jerky transverse slides are made across the skin above the left rectus abdominis muscle. The place where the sound changes from a loud rustling to a quiet one is the level of the greater curvature of the stomach.

Technique for palpation of the transverse colon. Palpation of the intestine is carried out with one (right) or two hands (Fig. 70).

The palpating hand is given the position necessary for palpating the intestines; it is placed on the stomach along the axis of the body at the outer edge of the rectus abdominis muscle(s). In this case, not a single finger of the palpating hand should lie on the rectus abdominis muscles. The fingers are located 2 cm below the level of the previously found greater curvature of the stomach along the expected projection of the intestine. As the patient inhales, the hand(s) are moved upward so that a skin fold forms in front of the nail surface of the fingers. After this, the patient is asked to exhale and, using the relaxation of the anterior abdominal wall, plunge the fingers of the hand(s) deep into the abdominal cavity until the fingertips touch the posterior abdominal wall. At the end of exhalation, slide your fingertips down along the posterior abdominal wall, and there should be a sensation of rolling over the roller of the transverse colon.

Peculiarities:

ü When palpating the sigmoid, cecum, ascending and descending colon, the skin moves towards the navel;

ü When palpating the transverse colon and greater curvature of the stomach, the skin moves upward from the navel.

ü When palpating the sigmoid colon, cecum, ascending and descending colon, slide (palpate) away from the navel.

ü When palpating the transverse colon and greater curvature of the stomach, they slide (palpate) down.

ü A second option for palpation of the sigmoid and descending colon is possible - moving the hand and sliding away from you, from right to left and, as it were, from bottom to top.

ü You can palpate the sigmoid colon not with four fingers, but with the ulnar side of only one little finger. But even in this case, all four moments of palpation are performed sequentially.

ü When the muscles of the anterior abdominal wall are tense, preventing palpation of the cecum, the thumb and the thenar area of ​​the left hand press in the navel area, thereby achieving some muscle relaxation (V.P. Obraztsov).

ü Before palpating the transverse colon, the lower border of the stomach should be determined (see below), since the transverse colon is usually located 2 - 3 cm below the stomach.

ü If at the first attempt it was not possible to clearly palpate the intestine, then the hand is moved left or right, higher or lower.

ü To more accurately determine the properties of the palpated organ, it is necessary to repeat palpation 2 - 3 times.

5.7.4. Palpation of the small intestine

Of all the parts of the small intestine, only the terminal segment of the ileum.

Execution technique.

ü The bent fingers of the right hand are placed in the depths of the right iliac fossa at the junction of the ileum and the colon.

ü During inhalation, the skin is moved towards the navel.

ü During exhalation, the right hand is immersed deep in the abdomen.

ü At the end of exhalation, they slide along the intestine outward (from the navel), perpendicular to the axis of the intestine.

All other parts of the small intestine are palpated in the mesogastrium, mainly around the navel. However, due to the absence of any dense bone formations here, it is impossible to press and clearly palpate individual sections of the small intestine. The condition of the small intestine can be judged by indirect signs - the presence of pain and tumor-like formations on palpation in this area. Damage to the small intestine is indicated by pain on palpation to the left and above the navel at the level of the XII thoracic and I lumbar vertebrae (Porges symptom).

5.7.5. Examination of intra-abdominal lymph nodes

With deep palpation of the abdomen, the mesenteric and para-aortic lymph nodes are examined.

1) Mesenteric lymph nodes determined in the peri-umbilical zone with the patient in the supine position with deep abdominal breathing, similar to the study of intestinal sections.

2) Para-aortic lymph nodes palpated to the right and left of the abdominal aorta along the midline of the abdomen in the epigastric and mesogastric region with deep breathing of the patient in position on your back. Move the hand from top to bottom from the epigastric to the umbilical region.

The same group of lymph nodes is also palpated in the position on the left side in the areas of the left and right hypochondrium and flanks.

Example of a conclusion for a norm:

When palpating the large intestine in the left iliac region, the sigmoid colon is felt in the form of a cylinder, up to 2 cm thick, its displacement up to 3 cm down and up. In the area of ​​the left flank, the descending colon is determined, up to 2.5 cm thick, with displacement up to 2 cm to the right and left. At the level of the navel, to the right and left of it, in the mesogastric region, the transverse colon is determined in the form of a cylindrical cord, up to 2 cm thick, its displacement is up to 3 cm. In the area of ​​the right flank, the ascending colon is palpable, 2.5 cm thick, displaceable it is 2-3 cm. In the right iliac region the cecum is palpated, displacement is within 1.5-2 cm. All parts of the large intestine have a smooth surface, elastic consistency, are painless and without rumbling.

To the left of the lower third of the ascending section of the large intestine, the final segment of the ileum is palpated in the form of an elastic, round, smooth cord up to 1.5 cm thick, painless. On palpation in the area of ​​the remaining parts of the small intestine (around the navel), pain, rumbling, and tumor-like formations are not detected. Mesenteric and para-aortic lymph nodes are not palpable.

Conclusion: variant of the norm.

Example of a pathology report:

With deep palpation of the abdomen in the left iliac region, a sigmoid colon 5 cm thick is palpated, inactive, painful, with a tuberous surface, almost woody density, without rumbling.

In the area of ​​the left flank, the descending colon is palpated in the form of a swollen cylinder, up to 3 cm wide, with a smooth surface, slightly painful, of medium density, without rumbling, displaced by 1.5 - 2 cm.

In the mesogastrium, 2 cm above the navel, the transverse colon is palpated in the form of a rounded cylinder, with a smooth surface, medium density, painless and without rumbling, with a mobility of 1.5 - 2 cm. The ascending colon could not be palpated.

In the right iliac region, the cecum is palpated in the form of a short rounded cylinder, up to 3 cm thick, with a smooth surface, medium density, painless, without rumbling.

When palpating the small intestine, no lumps, tumors, rumbling, or pain are detected. Mesenteric and para-aortic lymph nodes are not palpable.

Conclusion: symptoms of a malignant tumor of the sigmoid colon.

5.7.6. Palpation of the stomach

Performed in both vertical and horizontal positions of the patient. The lesser curvature of the stomach, as a rule, cannot be felt even in an upright position of the patient due to its high and deep location. However, in its zone (in the epigastric region, under the xiphoid process), tumor-like formations and pain can be detected in the patient.

Research technique.

1. Find lower border of the stomach(greater curvature). The simplest method for determining the position of the greater curvature of the stomach is ausculto-affriction method:

ü The phonendoscope membrane is placed in the epigastrium just to the left of the anterior midline. With the second finger of the right hand, “strokes” are applied in a radial direction along the front surface of the abdomen. In this case, loud scraping sounds are heard above the stomach, which stop at certain points (outside the projection zone of the stomach).

ü Mark these points and connect them to each other. The result is an arched line corresponding to the greater curvature of the stomach.

(carried out using the Obraztsov-Strazhesko method)

1. Palpation of the sigmoid colon:

a) place four slightly bent fingers of the right hand on the anterior abdominal wall at the border of the middle and outer third of the line connecting the navel with the anterior superior iliac spine, parallel to the length of the sigmoid colon;

b) while the patient inhales, create a skin fold by moving the fingers of the right hand towards the navel;

c) while the patient exhales, gently lower your fingers into the abdominal area;

d) having reached the posterior abdominal wall, slide along it perpendicular to the length of the sigmoid colon in the direction from the navel to the anterior superior iliac spine (palpating fingers roll through the sigmoid colon).

2. Palpation of the cecum:

a) place four half-bent fingers of the right hand, folded together, parallel to the length of the intestine;

b) while the patient inhales, move your fingers towards the navel to create a skin fold;

c) while the patient exhales, gradually immerse your fingers into the abdominal area, reaching the posterior abdominal wall;

d) slide along it perpendicular to the intestine, towards the right anterior iliac spine.

Determine the thickness, consistency, nature of the surface, pain, peristalsis, motility and rumbling of the cecum.

3. Palpation of the ascending and descending parts of the colon (first palpate the ascending part, then the descending part):

a) place the palm of the left hand under the right half of the lower back, and then under the left;

b) the left hand should be pressed to the corresponding half of the lumbar region and directed towards the palpating right hand (bimanual palpation).

c) place the fingers of the right hand, half bent at the joints and closed together, in the area of ​​the right and left flanks, along the edge of the rectus abdominis muscle, parallel to the intestine, at the place of its transition into the cecum (or sigmoid) colon;

d) while the patient inhales, create a skin fold with a superficial movement of the fingers of the right hand towards the navel;

e) while exhaling, immerse your fingers into the abdominal cavity up to the posterior abdominal wall until you feel a sensation of contact with your left hand;

f) with a sliding movement of the fingers of your right hand perpendicular to the axis of the intestine, roll them through the ascending (descending) segment.

Using bimanual palpation, you can palpate the ascending and descending segments of the colon in thin people with a thin and flaccid abdominal wall. This possibility increases with inflammatory changes in a particular segment and with the development of partial or complete obstruction of the underlying sections of the large intestine.

4. Palpation of the transverse colon:

a) place the bent fingers of both hands on the sides of the white line, parallel to the desired intestine, that is, horizontally, 2-3 cm below the greater curvature of the stomach;

b) by moving your fingers while the patient inhales, move the skin upward;

c) while exhaling, gradually immerse your fingers into the abdominal cavity until they touch its back wall and slide along it from top to bottom. When sliding, the fingers of one or both hands roll across the transverse colon.

If palpation is impossible, move your fingers down to the hypogastric region.

Normally, the intestine has the shape of a cylinder of moderate density, easily moves up and down, is painless, and does not rumble.

The process of palpation of the stomach and intestines is important in terms of diagnostic examination of the human body. Monitoring of the digestive organs is carried out as follows: at the first stage, a qualified specialist carefully palpates the sigmoid colon - this is the most common landmark and the most accessible organ for palpation. Next, the doctor proceeds to study the condition of the cecum and transverse colon. The ascending and descending sections of the suction organ are quite problematic to palpate.

In practice, during palpation, the fingers must be carefully immersed on the surface of the body area and gently pressed onto the organ being examined (toward the posterior abdominal wall). Using sliding movements, you can clearly determine the contours, density, and the presence of various neoplasms and abnormalities. When you touch (feel) the sigmoid colon, you get the impression that there is a smooth, dense and mobile cylinder in the human body. The size of such a “geometric figure” does not exceed the thickness of a person’s thumb. The formation parameters are directly related to the condition of the walls, which are densely filled with gases and decay products (feces/feces).

During the inflammatory process of the infiltrating walls, a significant thickening of the membrane occurs. Ulcerative manifestations form a lumpy and uneven surface of the suction organ. Acute inflammation of the sigmoid colon is accompanied by the formation of a dense consistency of painful manifestation. Due to the dense overflow of gases and liquid contents, motor inhibition occurs. The spasm is felt in the form of a cord and cord. The patient experiences systematic rumbling + false urge to defecate (false diarrhea).

In normal condition, the cecum is easily palpable. A specialist can detect a cylinder up to 3 cm that is moderately active in movements. Its mobility in a pathological disorder is significantly increased. The internal consistency becomes significantly thicker during coprostasis and chronic inflammation. The volume and shape of the cecum directly correlates with the contents. In a normal functional state, the intestines do not growl.

The patient should remember that the presence of pain upon palpation in the area of ​​the cecum indicates the development of a pathological process. The digestive organ requires systematic and comprehensive treatment.

In practice, after examining the cecum (+ appendix), it is possible to examine the less accessible parts of the large intestine. Palpation is carried out from the ascending to the transverse colon and descending colon. The transverse colon part of the suction organ can be qualitatively palpated only in the case of chronic inflammation. Tone, consistency, volume, shape depend on the tone and degree of muscle tension. For example, an inflammatory process of the ulcerative type forms serious preconditions for the transformation of the transverse colon. At the same time, the muscles of the organ thicken significantly, and its configuration changes.

Today, chronic colitis and percolitis are quite common. With these ailments, the wall of the suction organ begins to painfully contract. Due to the lumpy surface, palpation is accompanied by sharp pain. For example, with pericolitis, respiratory and active mobility is lost.

Palpation of the abdomen allows you to feel an intestinal tumor, which is often confused with the pathology of various organs. Oncology of the cecum and transverse colon is distinguished by already known mobility. The pain is activated during the act of breathing (tumors below the navel are motionless). Palpation of the abdomen during enterocolitis is accompanied by rumbling in the navel area. The disease has specific signs and symptoms: painful diarrhea (mushy, mucous stools, abdominal pain, hard colon). Palpation of the abdomen is carried out in combination with a digital examination of the rectum (sigmoidoscopy + radiography). These actions make it possible to predict the formation of rectal cancer and the formation of various syphilitic structures. It will also be possible to clearly determine the presence of inflammatory processes, cracks, fistulas, hemorrhoids and all kinds of tumors. The specialist can get a clear vision of the sphincter tone and the level of filling of the colon ampulla. In some cases, it is rational to palpate adjacent organs (bottom of the bladder, prostate gland, uterus with appendages). This will reveal an ovarian cyst, a tumor of the genital organs, the degree of constipation, etc.

Mechanism of the procedure

Palpation is the last stage of a full and objective examination of the abdominal area. The patient will need to cough vigorously before the procedure. In practice, a person with developed peritonitis manages to do this only superficially (holding his stomach with his hands). It is allowed to make a small impact on the couch on which the patient is located in a supine position. The vibration impulse will provoke the manifestation of pain in the gastrointestinal tract. Thus, it is quite easy to establish the diagnosis of peritonitis without touching the hand. To identify symptoms of peritoneal irritation, it is allowed to gently shake the patient after grasping the crests of the ileum (or jumping on one leg).

The palpation procedure begins with the patient being asked to clearly indicate the area where the first pain formed (the primary localization of the disease). The specialist needs to closely monitor the actions of the patient himself. This is how you can identify the causes of peritoneal irritation. Diffuse visceral pain in the abdomen is easily determined using circular movements of the palm. Your hands should be warm.

The procedure begins as far as possible from the main source of pain. This helps to avoid unplanned pain at the very beginning of the study. Children, and sometimes adult patients, sometimes prevent a quality examination due to pain.

First of all, the doctor must perform gentle and careful palpation (superficial). An experienced specialist moves gently, methodically and consistently. The fingers make a minimum number of movements. It is strictly forbidden to palpate the abdomen randomly! The pressure on the body surface should not be high. Otherwise, protective tension in the abdominal muscles will occur. Touching the sore spot must be done until the patient says that it really hurts.

A qualified specialist can always determine the degree of muscle tension in the anterior abdominal wall. The physician must distinguish between voluntary and involuntary muscle tension. To clearly determine this factor, during palpation a person takes a deep breath and exhales. If muscle activity persists, this indicates the development of peritonitis.

It is rational to carry out deeper palpation if peritonitis was not detected during a superficial examination. This makes it possible to detect various tumor formations, hepatosplenomegaly, and aortic aneurysm. It is very important for a physician to remember the optimal sizes for normal structures, so as not to confuse them with malignant ones. Pain on palpation of the abdomen and intestines has two types:

1. immediate local pain – the patient experiences sharp pain at the test site;
2. indirect (referred pain) – pain sensations are formed in a different place when palpated. For example, during acute appendicitis, pain accumulates at McBurney's point on the left side of the iliac fossa. This symptom is called “Roving” and is a reliable sign of peritoneal irritation.

It is easy to carry out comparative palpation of a patient with tense abdominal muscles. For this, the patient, who is in a supine position, is asked to gently lift his head above the pillow.

The classic symptom of parietal peritoneal irritation is not difficult to identify. To do this, at the time of the examination, the doctor must sharply remove his hand from the surface of the body and observe the patient’s reaction. In most cases, patients experience a significant increase in pain. This classic examination technique is quite crude; some scientists classify it as a barbaric method of study.

With the development of various pathologies in the digestive organs (for example, acute appendicitis), hyperesthesia of the skin in the abdominal area is observed. It is for this reason that if you pinch or lightly prick a patient, a painful reaction of the body will immediately occur. This is a fairly common clinical symptom, but its establishment is not enough to firmly diagnose acute appendicitis and other diseases of the abdominal organs.

An integral part of the palpation examination is gentle tapping on the lumbar region (+ sides of the abdomen) to determine the degree of pain in these areas. Quite often, pyelonephritis and urolithiasis correlate with severe pain in the abdomen (costovertebral region).

In doubtful clinical situations, examination alone is not enough. An accurate assessment of the dynamics of the disease is established by repeated palpation of the abdomen by the same doctor.

Types of pain syndromes

Causes of pain in women

Today, medicine identifies two types of fundamental causes that affect pain when palpated. Organic factors include:

• inflammatory processes in the genitourinary system (cyst, endometritis, fibroids);
• using the IUD as a contraceptive;
• formation of various pathological formations;
• the presence of inflammation in the gall bladder (including appendicitis, pyelonephritis);
• sharp pain during pregnancy (placental abruption, miscarriage).

The functional reasons are as follows:

• systematic disruptions in cycles during menstruation;
• discharge of uterine bleeding;
• ovulation + uterine inflection.

Inflammatory processes are the main cause of pain during palpation of the stomach and intestines. The disease begins with classic acute manifestations and is supplemented by various signs of intoxication of the body, namely:

1. Endometritis is accompanied by aching pain in the abdominal area. Their manifestation can be determined by light palpation. The patient experiences heaviness in the area of ​​the appendages + compaction of the uterus;
2. Endometriosis is a pathological disorder that affects the uterus and appendages. Severe pain is observed when palpating the middle of the abdomen;
3. Ovarian apoplexy correlates with ovulation. In this case, some of the blood penetrates into the abdominal cavity due to strong physical exertion;
4. Uterine fibroids. The pain syndrome is localized in the lower abdomen (compression of neighboring organs);
5. Appendicitis requires surgical medical intervention. Pain on palpation in the area where the appendix is ​​located;
6. Cholecystitis is an inflammatory process of the gallbladder. The pain radiates clearly to the lumbar region and back;
7. Cystitis is a lesion of the bladder. Pain is observed both during palpation and during urination.

Causes of pain in men

Pain on palpation in men is preceded by a number of factors. This can be either inflammation of the appendages, or prostatitis, cystitis, or various formations. Doctors identify some signs of pain that require hospitalization. If the pain is concentrated in the area where the appendix forms, this indicates appendicitis. An inguinal hernia and its pinching are also dangerous. The organ simply protrudes outward and has a hard cover. The patient experiences severe pain. Abdominal pain is also a consequence of poor quality food. Thus, a peptic ulcer is formed. The main causes of pain in men are: diverticulitis, genitourinary disease, cystitis, pyelonephritis and excessive hypothermia.

In some cases, sharp pain is localized not only on the right side, but also on the left. Quite often, the main reason lies in the spread of intestinal infection. In this case, the main symptoms of appendicitis are observed, which have a paroxysmal manifestation. The pain often intensifies during meals.

Getting started palpation of the cecum, we must remember that in normal cases it is located in the right iliac fossa, and the direction of its axis is somewhat indirect - namely to the right and from above - down and to the left. Therefore, remembering the mandatory rule for palpating the abdominal organs - to palpate in a direction perpendicular to the axis of the organ - it is necessary to palpate indirectly from the left and from top to right and downwards along the right umbilical spine line or parallel to it.

Usually when palpation It is most convenient to use 4 slightly bent fingers, which we gradually try to immerse into the abdominal cavity towards the inside from the location of the cecum. Taking advantage of the relaxation of the abdominal press during exhalation, and having reached the contact of the ends of the palpating fingers with the posterior wall of the abdominal cavity, we, without weakening the pressure, slide along it, while our fingers roll over the cecum and go around it for approximately 3/4 of its circumference .

Gausman advises palpation coeci to use oblique palpation with 3 fingers, but I don’t see any particular advantages in this technique and always use the typical palpation with 4 fingers, first proposed by Obraztsov. In most cases, with the first movement along the posterior surface of the iliac cavity, we are able to palpate the intestine. However, with some abdominal tension, it may be useful to transfer the abdominal resistance to another nearby area in order to reduce the resistance at the site of examination of the cecum.

For this purpose, on the advice Obraztsova, it is useful to use your free left hand, namely the thenar and the outer edge of the thumb, to press near the navel and do not ease the pressure during the entire examination. In other cases, with a high-lying cecum, when it lies, therefore, in the right flank, it is useful to place the left hand flat under the right lumbar region in order to create a more dense wall against which the cecum is pressed during palpation. In other words, you need to use bimanual palpation.

If at the first moving the movement of our fingers we do not palpate the intestines, this usually depends on the fact that its walls are in a relaxed state and, therefore, in order to palpate, we need to wait for their physiological contraction. According to Gausmann's statistics, the normal cecum is palpable in 79%, therefore quite often, although less often than S.R.

I must say that I am blind gut first palpated Glenard in 10% in the form of an oval body the size of a chicken egg (boudin coecal) and considered its palpability a pathological phenomenon, depending on the tension of its walls due to narrowing of the colon above the cecum. Only Obraztsov showed that a completely normal cecum can also be palpated. When palpating the cecum, we usually find not only the cecum, but at the same time we also palpate some part of the ascending colon over a length of 10-12 cm, i.e., what is commonly called typhlon in the clinic.

According to Obraztsov, longitudinal axis of the cecum is separated from the spina osis ilei anterior superior by an average of 5 cm, and the lower border of the cecum, on average, lies slightly above the interspinous line in men, and at its level in women. But Obraztsov already drew attention to the fact that the position of the coeci is individually different and fluctuates within fairly wide limits.

Currently time after work Wandel, Faltin"a and Ekehorn"a, Wilms"a, Klose and others, we know that the position of the coeci, its thickness and length and the methods of its attachment are individually so different that it is difficult in this regard to find two identical cases. Normally we palpate the cecum (typhlon) in the form of a smooth two-finger-wide, slightly rumbling, painless on palpation and moderately mobile cylinder with a small pear-shaped blind extension downwards (the cecum itself), with moderately elastic walls.