Relations of the stomach

• Anteriorly—the abdominal wall, the left costal margin, the diaphragm and the left lobe of the liver.

• Posteriorly—the lesser sac, which separates the stomach from the pancreas, transverse mesocolon, left kidney, left suprarenal, the spleen and the splenic artery.

• Superiorly—the left dome of the diaphragm.

The lesser omentum is attached along the lesser curvature of the stomach, the greater omentum along the greater curvature. These omenta contain the vascular and lymphatic supply of the stomach.

The arterial supply (Fig. 53) to the stomach is extremely rich and comprises:

• the left gastric artery—from the coeliac axis;

• the right gastric artery—from the hepatic artery;

Diaphragm

Transverse colon and mesocolon

Blood Supply Transverse Colon

Left kidney and suprarenal

Pancreas and splenic artery

Fig. 52 The posterior relations of the stomach; the stomach (grey tint) is superimposed upon its bed.

Diaphragm

Left kidney and suprarenal

Pancreas and splenic artery

Transverse colon and mesocolon

Fig. 52 The posterior relations of the stomach; the stomach (grey tint) is superimposed upon its bed.

Left gastric artery Coeiiac axis

Cystic artery Hepatic artery

Right gastric artery Gastro duodena I artery

Superior pancreaticoduodenal artery

Superior pancreaticoduodenal artery

Gastric Artery

Short gastric arteries

Splenic artery

Left gastro-epiploic artery

Right gastro-epiploic artery

Short gastric arteries

Splenic artery

Left gastro-epiploic artery

Right gastro-epiploic artery

Fig. 53 The arterial supply of the stomach.

Fig. 53 The arterial supply of the stomach.

Stomach Arteries

Fig. 54 The lymph drainage of the stomach.

• Area I drains along the right and left gastric vessels to the aortic nodes.

• Area II drains to the subpyloric and thence aortic nodes via lymphatics along the right gastro-epiploic vessels.

• Area III drains via lymphatics along the splenic vessels to the suprapancreatic nodes and thence to aortic nodes.

• the right gastro-epiploic artery—from the gastroduodenal branch of the hepatic artery;

• the left gastro-epiploic artery—from the splenic artery;

• the short gastric arteries—from the splenic artery. The corresponding veins drain into the portal system.

The lymphatic drainage of the stomach accompanies its blood vessels. The stomach can be divided into three drainage zones (Fig. 54).

• Area I—the superior two-thirds of the stomach drain along the left and right gastric vessels to the aortic nodes.

• Area II—the right two-thirds of the inferior one-third of the stomach drain along the right gastro-epiploic vessels to the subpyloric nodes and thence to the aortic nodes.

• Area III — the left one-third of the greater curvature of the stomach drains along the short gastric and splenic vessels lying in the gastrosplenic and lienorenal ligaments, then, via the suprapancreatic nodes, to the aortic group.

This extensive lymphatic drainage and the technical impossibility of its complete removal is one of the serious problems in dealing with stomach cancer. Involvement of the nodes along the splenic vessels can be dealt with by removing spleen, gastrosplenic and lienorenal ligaments and the body and tail of the pancreas. Lymph nodes among the gastro-epiploic vessels are removed by excising the greater omentum. However, involvement of the nodes around the aorta and the head of the pancreas may render the growth incurable.

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  • heike fried
    What are the relations of the stomach?
    3 years ago

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