Report of an autopsy on the bodies of Chang and Eng Bunker, commonly known as the Siamese twins

by Harrison Allen

Fig. 6. The abdominal organs in Eng—the small intestines removed. A. Left lobe of liver. B. Right lobe of liver. C. Gall-bladder. D. Suspensory ligament. E. Lobules of fat in the position of the termination of the umbilical ligament.

The liver.—The right lobe was alone visible. This extended entirely across the right hypochondriac and epigastric regions. Its external free border was not in contact with the ribs. Between it and the external abdominal wall there was an interval of nearly an inch at its greatest part, which was crossed by the external lateral ligament. The inferior border of the lobe rested upon and nearly concealed the pylorus of the stomach as well as the upper half of right kidney. Corresponding in position to the upper portion of the right kidney was a well-defined layer of peritoneum, presenting a sharply defined internal border. Upon dissecting away the peritoneum from this border it was found to answer to the inferior vena cava. The lesser omentum occupied its usual position. The fundus of the gall-bladder was two-thirds of an inch beyond the anterior border of the lobe, immediately to the outer side of the caudal lobe. The position of the longitudinal fissure was well off to the left side of the abdomen, presenting, between the right and left lobes, a conspicuous cleft which was partially occupied by the base of the caudal lobe. The round ligament, with its associated suspensory ligament, had doubtless passed nearly vertically, before the relations had been disturbed by the incision in the abdominal wall, upwards and forwards to the anterior abdominal wall at a point lying one inch to the outer side of the centre of the umbilicus.

In the subject, as it lay on the table with the flap a, b (Fig. [2]), turned to the left, the suspensory ligament had the appearance of being much more obliquely inclined to the left, and could be made nearly horizontal by a little traction. Lying beneath this ligament, but belonging to the anterior abdominal wall, was a large mass of subperitoneal fat about the size of a pigeon’s egg. Extending to the extreme left, and continuous with the anterior border of the left lobe of the liver, was a delicate prolongation of liver substance which was lost within the connecting band.

Fig. 7. The abdominal organs of Chang in position—the small intestines removed. A. Left lobe of liver. B. Right lobe of liver. C. Gall-bladder. D. Suspensory ligament. E. Lobules of fat in the position of the termination of the umbilical ligament.

The upper surface of this prolongation was supported by a fold of peritoneum, extending directly upward, apparently attached to the base of the ensiform cartilage. Visible upon the anterior aspect of this fold was a tortuous artery, afterwards found to be the left internal mammary. This fold may be called the accessory suspensory ligament; nothing similar to it was seen in Chang. The left lobe of the liver, save a portion of its anterior edge, was not visible.

In Chang (Fig. [7]), by exposing the parts as in Eng, throwing the abdominal flap, c, d (Fig. [2]), to the right, there was at once brought into view the transverse colon, the greater omentum, and greater curvature of the stomach. The latter organ was large, empty, and without any undue traction could be so displayed as to yield its fundus and greater curvature in position. The fundus was not visible. Lying conspicuously within the left hypochondriac region was the spleen. Its inferior free border, with its peritoneal attachment, was distinctly seen; its upper portions, however, were invisible. The left lobe of the liver held a position answering to that of the right lobe in Eng—the external lateral ligament being stretched across the left hypochondriac region, pursuing a similar course to the external lateral ligament of Eng (q. v.). The left lobe at its outer portion rested upon the spleen, its inner portion upon the stomach. The outer portion of the left lobe presented a thin compressed border, the inner portion was divided by a deep sulcus into two lobes.

The right lobe lay deep within the right hypochondriac region, the portion about the longitudinal fissure anteriorly, alone appearing in the dissection. The suspensory ligament held a position similar to that in Eng. The gall-bladder held its normal position to the right lobe, and was moderately distended with bile.

Both Chang and Eng had the organs occupying the hypochondriac and epigastric regions retaining, on the whole, such relations as are usually observed.