The omentum is fatty. Tumors of the peritoneum and omentum

Small seal (omentum minus)- sheets of visceral peritoneum, passing from the liver to the stomach and duodenum. It consists of 3 ligaments that directly pass from left to right into one another: the gastrodiaphragmatic (lig. gastrophrenicum), hepatic-gastric (lig. hepatogastricum) and hepatoduodenal (lig. hepatoduodenale).

In the hepatogastric ligament, on the lesser curvature of the stomach, the left gastric artery passes, anastomosing with the right gastric artery running from the right. The veins and lymph nodes of the same name are also located here.

The hepatoduodenal ligament, which occupies the extreme right position within the lesser omentum, has a free edge on the right, which is the anterior wall of the omental foramen (foramen omentale - epiploicum, Winslowi).

Ligaments pass between the leaves: on the right - common bile duct and the common hepatic and cystic ducts forming it, on the left - the proper hepatic artery and its branches, between them and behind - the portal vein, as well as lymphatic vessels and nodes, nerve plexuses.

Big seal (omentum majus) in systemic anatomy, these are ligaments passing from the diaphragm to the fundus, the greater curvature of the stomach and the transverse colon (anterior leaf), to the kidney and spleen, the anterior surface of the pancreas and the transverse colon (posterior leaf), from in which the leaves connected here continue down into the lower floor of the abdominal cavity.

This is the gastrophrenic ligament (lig. gastrophrenicum), gastrosplenic ligament (lig. gastrosplenicum (lig. gastrolienale), gastrocolic ligament (lig. gastrocolicum), diaphragmatic-splenic (lig. phrenicosplenicum), splenorenal (lig. splenorenale (lig. lienorenale), pancreasplenic (lig. pancreaticosplenicum), diaphragmatic-colic ligament (lig. phrenicocolicum).

IN clinical anatomy The greater omentum is considered to be only the gastrocolic ligament (the upper part of the omentum) and the free lower part hanging down.

Lig. gastrocolicum contains between its leaves vasa gastroomentalis (gastroepiploica) dextra et sinistra And The lymph nodes.

1.4 Topography of the stomach (gaster, ventriculus)

The following anatomical structures can be distinguished in the stomach:

cardial foramen (ostium cardiacum);

---------------- minor and major curvature (curvatura minor et curvatura major);

---------------- front and back walls (paries anterior et posterior);

・cardiac notch (incisura cardiaca), located on the border of the esophagus with the greater curvature of the stomach.

Conventionally, the stomach is divided into 5 parts:

1) cardiac part (pars cardiaca)- a narrow strip of the gastric wall around the opening of the same name;

2) fundus of the stomach (fundus ventriculi)- part located above the cardial opening;

3) body of the stomach (corpus ventriculi), bordering the cardiac part and the fundus of the stomach from above, bounded below by the angular notch (incisura angularis);

4) gatekeeper cave (antrum pyloricum), located below the corner notch;

5) gatekeeper (pylorus ventriculi)- a narrow strip of the gastric wall at the location of the pyloric sphincter (sphincter pylori).

Holotopia

The stomach is projected onto the anterior abdominal wall in the area of the left hypochondrium and the epigastric region itself, and when the stomach is full, the greater curvature is projected into upper section umbilical region.

Skeletotopy of the stomach

---------------- The cardiac foramen lies to the left of the bodies of the X–XI thoracic vertebrae;

。 The outlet of the pylorus lies at the right edge of the XI thoracic or I lumbar vertebrae.

Syntopy

organs of the retroperitoneal space (pancreas, left adrenal gland, upper pole of the left kidney); the spleen is adjacent to the stomach on the left and behind; the lesser curvature is covered by the left lobe of the liver; greater curvature is in contact with the transverse colon and its mesentery.

Ligaments, relation to the peritoneum

The stomach is an intraperitoneal organ; both its anterior and posterior walls are covered with peritoneum, and only narrow strips along the greater and lesser curvature between the leaves of the lesser omentum and the gastrocolic ligament remain uncovered by peritoneum.

The ligaments of the stomach are divided into superficial and deep. The superficial ligaments include: hepatogastric, gastrocolic, gastrosplenic, gastrophrenic and diaphragmatic-esophageal ligaments. The deep gastric ligaments can be examined after dividing the gastrocolic ligament and moving the greater curvature upward. In this case, 2 folds of the peritoneum are stretched from the upper edge of the pancreas: the gastropancreatic and pyloric-pancreatic ligaments (see above).

The blood supply to the stomach is carried out by the branches of the celiac trunk (truncus celiacus), departing from the abdominal aorta at the level of the XII thoracic vertebra and dividing into 3 vessels: the left gastric, splenic and common hepatic arteries.

Along the lesser curvature (in the lesser omentum) the following is anastomosed:

􀀹 gastrica sinistra(branch of the celiac trunk), passes into lig. gastropancreaticum, where it gives off a branch to the esophagus, and then goes to lig. hepatogastricum;

􀀹 a. gastrica dextra- branch a. hepatica propria, passes into ligg. hepatoduodenale et hepatogastricum.

Along the greater curvature they anastomose:

􀀹 a. gastroepiploica dextra- branch a. gastroduodenalis;

􀀹 a. gastroepiploica sinistra- branch a. lienalis, extending from the celiac trunk, is located in lig. gastroliennale.

To the bottom of the stomach lig. gastroliennale are coming aa. gastricae breves from the splenic artery.

Venous drainage from the stomach it is carried into the portal vein system (v. portae).

Right and left gastric veins (vv. gastricae dextra et sinistra) drain directly into the portal vein.

Left gastroepiploic and short gastric veins (v. gastroepiploica sinistra et vv. gastricae breves) drain into the splenic vein ( v. lienalis), which, in turn, flows into the portal vein.

Right gastroepiploic vein (v. gastroepiploica dextra) drains into the superior mesenteric vein (v. mesenterica superior), also flowing into the portal vein.

On the anterior surface of the pylorus at its junction with the duodenum there is v. prepylorica (vein of Mayo), which is an anastomosis between the right gastric and right gastroepiploic veins. During surgical interventions, this vein serves as a guide for finding the border between the pylorus and the duodenum.

Lymphatic drainage from the stomach occurs through lymphatic vessels running near the vessels supplying blood to the stomach, through the 1st and 2nd order lymph nodes.

Regional lymph nodes of the 1st order:

right and left lymph nodes (nodi lymphatici gastrici dextri et sinistri) located in the lesser omentum;

right and left gastroepiploic lymph nodes (nodi lymphatici gastroomentales dextri et sinistri) located in the ligaments of the greater omentum;

Gastro-pancreatic lymph nodes (nodi lymphatici gastro-ncreatici) located in the gastropancreatic ligament.

The 2nd order lymph nodes for the organs of the upper floor of the abdominal cavity are the celiac lymph nodes (nodi lymphatici celiacae).

The vagus nerves innervate the stomach (nn. vagi) and branches of the celiac plexus (plexus celiacus).

The anterior (left) vagus trunk, located on the anterior surface of the abdominal esophagus, when approaching the stomach, breaks up into branches going to the anterior surface of the stomach. It gives off branches to the esophagus, the cardiac part of the stomach, to the fundus, between the leaves of the lesser omentum it gives off hepatic branches, and the rest of the left trunk follows along the anterior edge of the lesser curvature of the stomach and breaks up into numerous gastric branches. The longest branch extending from the main trunk and going to the pyloantral part of the stomach is called Latarget branch(left).

The posterior (right) vagus trunk lies between the posterior surface of the esophagus and the abdominal aorta. In the area of the cardia, it also splits into a number of branches going to the esophagus, to the posterior surface of the fundus and body of the stomach. Its largest branch goes to lig. gastropancreaticum on the left of a. gastrica sin-istra to the celiac plexus (celiac branches), and the longest (right Latarget branch) - to the posterior surface of the pyloric antrum of the stomach. A small branch may arise from the posterior trunk of the vagus nerve, which goes to the left behind the esophagus to the stomach in the area of the angle of His (“criminal” nerve of Grassi). If during vagotomy this branch remains uncrossed, then recurrent ulcers occur.

1.5 Topography duodenum (duodenum)

The duodenum is divided into 4 sections: the upper horizontal, descending, lower horizontal and ascending parts.

Upper horizontal part (pars horizontalis superior) lies on level I lumbar vertebra. It is located in the upper floor of the abdominal cavity: intraperitoneally - in the initial part, where the hepatoduodenal ligament fits, mesoperitoneally - in the middle part and retroperitoneally - in the area of the superior bend. At the top it comes into contact with gallbladder and the quadrate lobe of the liver, below - with the head of the subgastric gland, behind - with the body of the first lumbar vertebra and in front - with the antrum of the stomach.

Descending part (pars descendens) goes to the right of the spinal column at level LI–LIII. The upper section of the descending part of the intestine is located above the mesentery of the transverse colon, i.e. in the upper floor of the abdominal cavity. The middle section (about the same length) lies behind the root of the mesentery of the transverse colon. The lower section, up to 6 cm long, is located below the mesentery of the transverse colon, to the right of the root of the mesentery small intestine in the lower floor of the abdominal cavity. It is located retroperitoneally; The peritoneum, when passing to the right kidney, forms the duodenal-renal ligament. The mucous membrane has a small (0.5–1 cm in length) longitudinal fold (plica longitudinalis duodeni), which ends with an elevation - the large duodenal papilla (papilla of Vater, papilla duodeni major), at which the hepatic-pancreatic ampulla opens (ampulla hepatopancreatica).

In cases where there is an accessory duct of the pancreas (ductus pancreaticus accessorius), it opens on the intestinal mucosa slightly above the main duct on the small duodenal papilla (papilla duodeni minor).

The descending part contacts on the left with the head of the pancreas, behind and on the right with the right kidney, right renal vein, inferior vena cava and ureter; in front - with the mesentery of the transverse colon and below its attachment - with the loops of the small intestine.

Bottom horizontal part (pars horizontalis inferior) lies at level LIII. It is located retroperitoneally. It borders with the head of the pancreas above, with the inferior vena cava and abdominal aorta behind, and with the loops of the small intestine in front and below.

Rising part (pars ascendens) goes at level LIII to the left and up to the duodenum-jejunal flexure (flexura duodenojejunalis), located at level LII and fixed Treitz's ligament. The ascending part of the intestine is located mesoperitoneally; from above it is in contact with the lower surface of the body of the pancreas, behind - with the inferior vena cava and abdominal aorta, in front and below - with the loops of the small intestine.

The hepatoduodenal ligament is located between the porta hepatis and the upper wall of the duodenal bulb, it is the outermost right side lesser omentum and limits the omental opening in front.

The duodenal ligament is stretched between the outer posterior edge of the descending part of the duodenum and the area right kidney, it limits the stuffing box opening from below.

Treitz's ligament keeps the duodenum-jejunal flexure in its normal position. It is formed by a fold of peritoneum covering the muscle that suspends the duodenum.

The blood supply is carried out by the branches of the celiac trunk (anterior and posterior superior pancreaticoduodenal arteries) and the superior mesenteric artery (anterior and posterior inferior pancreaticoduodenal arteries), which anastomose with each other at the level of the middle of the descending part of the duodenum.

Venous outflow is carried out through the veins of the same name into the portal vein system.

Lymphatic drainage is carried out into the upper and lower pancreaticoduodenal lymph nodes and further into the celiac lymph nodes.

The innervation of the duodenum is carried out by the branches of the celiac, superior mesenteric, hepatic, gastric plexuses, and both vagus nerves.

1.6 Liver topography (hepar), modern ideas about the segmental structure of the liver

Inflammatory disease of the omentum, which is a fold of the visceral peritoneum. The disease manifests itself as acute diffuse abdominal pain, nausea, fever, headache, and vomiting. Patients assume a forced half-bent position, and sharp pain occurs when straightening the torso. Diagnostics includes examination by a surgeon, omentography, CT scan of the abdominal cavity, diagnostic laparoscopy. Treatment acute pathology surgical. The omentum is removed, the abdominal cavity is inspected, and drainage is installed. At chronic course Antibacterial and anti-inflammatory drugs are prescribed in combination with physiotherapy.

General information

Omentitis is a pathology of the abdominal cavity, which is manifested by inflammation of the omentum - a duplication of the peritoneum, consisting of abundantly vascularized loose connective tissue and fatty tissue. Anatomically, the lesser and greater omentum are distinguished. The latter starts from the stomach, is fixed to the transverse colon, continues down, freely covering small intestine. The lesser omentum consists of 3 ligaments that stretch from left to right from the diaphragm to the stomach, then to the liver and duodenum. Rarely isolated lesions of the greater omentum (epiploitis) and ligamentous apparatus (ligamentitis) occur. Omentitis occurs more often in children and adolescents due to imperfect functioning immune system And gastrointestinal tract.

Causes of omentitis

Based on etiology inflammatory process, the disease can be primary and secondary. Primary omentitis is formed as a result of traumatic injury, infectious infection and intraoperative damage to the peritoneum. In this case, the infection occurs directly in the peritoneal duplication. Isolated damage to the omentum area is found in tuberculosis and actinomycosis. In surgery, predominantly secondary inflammation occurs, which occurs as a result of the following reasons:

Contact transmission of infection. The disease is formed when inflammation passes from a nearby organ as a result of cholecystitis, pancreatitis, appendicitis, etc.
Endogenous infection. With the flow of blood or lymph from the primary infectious focus (in the lungs, gastrointestinal tract, liver, etc.), pathogenic microorganisms enter the omentum and cause its inflammation.
Intraoperative infection. Occurs as a result of violation of asepsis and/or antisepsis during intra-abdominal interventions (insufficient sterilization of instruments, surgeon’s hands, surgical field, leaving foreign objects in the abdominal cavity - ligatures, napkins).
Abdominal surgeries. Carrying out surgical manipulations for appendicitis, strangulated hernia, etc. can lead to torsion of the omentum, impaired blood circulation in it, and the development of ischemia and inflammation. The cause of omentitis may be resection of an organ with a poorly formed stump.

Pathogenesis

Due to the abundant blood supply and large amount of loose adipose tissue, the omentum is quickly involved in the process of inflammation. The organ has resorptive and adhesive abilities and performs protective function in organism. At mechanical damage, ischemia, infectious process The immunological activity of cells, the ability to absorb fluid from the abdominal cavity increases, and the hemostasis system is activated. With omentitis, there is hyperemia, swelling of the folds of the peritoneum with fibrous layering and infiltrative compaction of tissue. At histological examination signs of inflammation are detected (thrombosis and congestion of blood vessels, hemorrhages, islands of necrosis), areas of leukocyte infiltration, a large number of eosinophils, lymphocytes. With tuberculous omentitis, multiple whitish tubercles are visualized. Small formations acquire a reddish color when the organ comes into contact with air during surgical procedures.

Classification

Based on the severity of the inflammatory process, acute and chronic omentitis are distinguished. Acute form The disease is accompanied by pronounced symptoms with increasing intoxication; chronic is characterized by a sluggish course with periods of exacerbation and remission. Depending on the degree of inflammatory-destructive changes, 3 stages of omentitis are distinguished:

Serous. It manifests itself as swelling and hyperemia of omental tissue without signs of destruction. The inflammatory process is reversible. At this stage, complete tissue regeneration is possible with conservative therapy.
Fibrous. The hyperemic omentum becomes covered with a coating of fibrin and acquires a whitish-gray color. There are isolated hemorrhages and impregnation of organ tissues with fibrin threads and leukocytes. As a result of the disease, incomplete regeneration with replacement of part of the affected areas is possible connective tissue and the formation of adhesions.
Purulent. The organ acquires a gray, purplish-bluish, dark brown tint, which indicates deep intracellular damage. Often the greater omentum is fixed to the appendix, forming a single conglomerate. The histological picture is represented by multiple large focal hemorrhages, areas of impaired tissue microcirculation and necrosis. It is possible for acute omentitis to become chronic. The outcome of the purulent process is the replacement of the necrotic part of the organ with connective tissue and the formation of adhesions.

Symptoms of omentitis

The clinical picture of the pathology depends on the nature of the inflammatory process and the causes of the disease. In acute omentitis, patients complain of intense sharp pains in the abdomen, without clear localization. Signs of intoxication develop: vomiting, increased body temperature to febrile levels, headache, dizziness. When examining, pays attention muscle tension abdominal wall, sometimes a painful formation of dense consistency is palpated. A pathognomonic sign is the inability to straighten the torso, due to which the patient is in a semi-bent state. Adhesive processes in the abdominal cavity can lead to disruption of the passage of food through the intestines, constipation, partial or complete intestinal obstruction.

Chronic omentitis is characteristic of postoperative and tuberculous inflammation, manifested by discomfort and aching pain in the abdomen, symptoms of intoxication are absent or mild. With deep palpation of the anterior abdominal wall, a mobile formation of doughy consistency is determined, often painless.

Complications

Isolation of inflammation leads to the formation of an omental abscess. When the abscess breaks through, peritonitis develops, and when it gets into pathogenic microorganisms into the bloodstream - bacteremia. In severe advanced cases, necrosis of the peritoneal fold occurs. This condition is accompanied by severe intoxication of the body and can lead to the development of infectious-toxic shock and, in the absence of urgent measures, to fatal outcome. Chronization of omentitis, fixation of the organ to the peritoneum (visceral or parietal layer) entails the occurrence of tense omentum syndrome, which is characterized by positive symptom Knokha (increased pain when hyperextending the body).

Diagnostics

Due to the rarity of the disease and the lack of a specific clinical picture, preoperative diagnosis presents significant difficulties. To diagnose omentitis, it is recommended to carry out the following examinations:

Examination by a surgeon. This pathology It is almost never diagnosed during a physical examination, but a specialist, suspecting an acute surgical pathology, refers the patient for additional instrumental diagnostics.
Omentography. Represents X-ray examination with the introduction of radiopaque agents into the abdominal space. Allows you to detect an increase in the inflamed organ, adhesions, and foreign bodies.
Abdominal CT. Visualizes additional education, inflammatory infiltrate and changes in neighboring organs. Helps identify the cause of intestinal obstruction.
Diagnostic laparoscopy. This method is the most reliable in diagnosing the disease, allowing for a detailed assessment of changes in the omentum, the condition of the peritoneum, the nature and amount of fluid in the abdominal cavity. If tuberculous omentitis is suspected, material can be collected for histological examination.
Laboratory research. Are nonspecific method diagnostics For acute stage The disease is characterized by leukocytosis, neutrophilia, accelerated ESR.

Differential diagnosis of omentitis is carried out with other inflammatory intraperitoneal diseases (appendicitis, cholecystitis, pancreatitis, colitis). The pathology may have similar symptoms to peritonitis, perforated gastric ulcer, 12-PC, intestinal obstruction other etiology. The disease is differentiated from benign and malignant neoplasms intestines, mesentery. For additional diagnostics and to rule out diseases of nearby organs, an ultrasound scan of the peripheral organs is performed.

Treatment of omentitis

In case of severe organ damage and severe clinical picture carry out urgent surgical intervention. During the operation, based on the extent of the lesion, an omentectomy and a thorough examination of the abdominal cavity are performed. The resection line is invaginated and sutured with thin catgut threads. Injected into the abdominal cavity antibacterial drugs and install drainage. IN postoperative period antibiotics and analgesics are prescribed.

With confirmed chronic omentitis, conservative therapy is possible. In a hospital setting, antibacterial drugs are prescribed according to the sensitivity of the infectious agent, anti-inflammatory and painkillers. Patients are advised to rest and stay in bed. After the inflammation subsides, a course of physiotherapeutic procedures (UHF, magnetic therapy, solux therapy) is performed.

Prognosis and prevention

The prognosis of the disease depends on the severity of the pathology and the extent of damage to the omentum. With a timely operation and proper management of the rehabilitation period, the prognosis is favorable. Patients return to their normal lifestyle after a few months. Generalized damage with acute intoxication leads to the development of severe life-threatening conditions (shock, sepsis). Prevention of omentitis consists of a thorough intra-abdominal revision when performing laparotomy, timely treatment acute and chronic diseases. Ultrasound monitoring is recommended for patients after undergoing interventions on the obstructive pelvis 1-2 times a year.

This necessarily accompanies surgery for certain types of abdominal cancer. It is important that during all these operations abdomen was opened with an extensive longitudinal incision. It is difficult to perform a full omentectomy through a transverse incision, and often the result of such difficult operations is incomplete removal of the metastatic omentum. If the removed omentum does not externally show signs of damage, it should be carefully examined for the presence of micrometastases.

The purpose of the operation to remove the greater omentum is to remove the omentum with all macro- and micrometastases.

Physiological consequences of removing the oil seal- none.

Progress of the oil seal removal operation

Features of the operation:

The greater omentum must be cut off from the greater curvature of the stomach and from the transverse colon.
Small branches of the right gastric artery should be ligated especially carefully. Reliable hemostasis is necessary.
In cases malignant tumor It is recommended to remove the greater omentum from the stomach due to the possible implantation of metastases into this structure.

Removing the greater omentum is not difficult and usually requires less technical effort than dividing the gastric and colon ligament adjacent to the greater curvature. Therefore, some prefer to constantly use this operation, regardless of the indication for almost complete. The transverse colon is removed from the wound, and with assistants, the omentum is lifted steeply up and held. Using Metzenbaum scissors, begin excision with right side adjacent to the posterior cord of the colon. In many cases, the peritoneal junction may be easier to divide with a scalpel than with scissors. A thin and relatively avascular peritoneal layer can be seen, which can be quickly cut. The greater omentum continues to be pulled upward, while using blunt separation with gauze, the colon is moved downward, freeing it from the omentum. As this procedure progresses, several small blood vessels in the anterior cord of the colon may require division and ligation. Eventually, a thin, avascular peritoneal layer over the colon will be visible. It is dissected, obtaining direct entry into the omental bursa. In obese patients, as a preliminary step, it may be easier to separate the connections of the omentum to the lateral wall of the stomach under the spleen.

If the upper edge of the splenic flexure is clearly visible, then the ligament of the spleen and colon is divided and the omental bursa is entered from the left side, and not over the transverse colon. The surgeon must constantly be careful not to injure the splenic capsule or the middle vessels of the transverse colon, since the transverse mesentery may be closely adjacent to the ligament of the stomach and colon, especially on the right. As the division moves to the left, the omentum of the stomach and colon is divided, and the greater curvature of the stomach is separated from its blood supply to the desired level. In some cases, it may be easier to ligate the splenic artery and vein along the superior surface of the pancreas and remove the liver, especially if there is a malignant tumor in the area. It should be remembered that if the left gastric artery is ligated proximal to its bifurcation and removed, the blood supply to the stomach becomes so compromised that the surgeon is forced to perform a complete gastrectomy.

If a malignant tumor is present, the greater omentum over the head of the pancreas is removed, as well as the subpyloric lymph nodes. When approaching the duodenal wall, small curved forceps should be used, and the mid-bowel vessels, which may be adjacent to the gastric-colon ligament at this point, should be carefully inspected and circumvented before clamps are applied. If you are not careful, severe bleeding may occur and the blood supply to the intestine will be at risk.

The article was prepared and edited by: surgeon

Between the leaves of the ligament pass: on the right - the common bile duct and the common hepatic and cystic ducts that form it, on the left - the proper hepatic artery and its branches, between them and behind - the portal vein, as well as lymphatic vessels and nodes, nerve plexuses.

This is the gastrophrenic ligament (lig. gastrophrenicum) , gastrosplenic ligament (lig. gastrosplenicum (lig. gastroliennale) , gastrocolic ligament (lig. gastrocolicum) , diaphragmatic-splenic (lig. phrenicosplenicum) , splenorenal (lig. splenorenal (lig. lienorenale) , pancreasplenic (lig. pancreaticosplenicum) , diaphragmatic-colic ligament (lig. phrenicocolicum) .

In clinical anatomy, only the gastrocolic ligament (the upper part of the omentum) and the free lower part hanging down are considered the greater omentum.

Lig. gastrocolicum contains between its leaves vasa gastroomentalis (gastroepiploica) dextra et sinistra and lymph nodes.

1.4 Topography of the stomach (gaster, ventriculus)

The following anatomical structures can be distinguished in the stomach:

Cardiac foramen (ostium cardiacum);

small and large curvature (curvatura minor et curvatura major);

---------------- front and back walls (paries anterior et posterior);

----------------cardiac notch (incisura cardiaca), located on the border of the esophagus with the greater curvature of the stomach.

Conventionally, the stomach is divided into 5 parts:

1) cardiac part (pars cardiaca)- a narrow strip of the gastric wall around the opening of the same name;

2) fundus of the stomach (fundus ventriculi)- part located above the cardial opening;

3) body of the stomach (corpus ventriculi), bordering the cardiac part and the fundus of the stomach from above, bounded below by the angular notch (incisura angularis);

4) gatekeeper cave (antrum pyloricum), located below the corner notch;

5) gatekeeper (pylorus ventriculi)- a narrow strip of the gastric wall at the location of the pyloric sphincter (sphincter pylori).

Holotopia

Skeletotopy of the stomach

The cardiac foramen lies to the left of the bodies of the X–XI thoracic vertebrae;

The outlet of the pylorus lies at the right edge of the XI thoracic or I lumbar vertebrae.

Syntopy

The anterior wall of the stomach is covered on the right by the liver, on the left by the costal part of the diaphragm, part of the body and pylorus are adjacent to the anterior abdominal wall; the posterior wall is separated by the omental bursa from the organs of the retroperitoneal space (pancreas, left adrenal gland, upper pole of the left kidney); the spleen is adjacent to the stomach on the left and behind; the lesser curvature is covered by the left lobe of the liver; the greater curvature is in contact with the transverse colon and its mesentery.

Ligaments, relation to the peritoneum

Along the lesser curvature (in the lesser omentum) the following is anastomosed:

􀀹 gastrica sinistra(branch of the celiac trunk), passes into lig. gastropancreaticum, where it gives off a branch to the esophagus, and then goes to lig. hepatogastricum;

􀀹 a. gastrica dextra- branch a. hepatica propria, passes to ligg. hepatoduodenale et hepatogastricum.

The greater curvature is anastomosed:

􀀹 a. gastroepiploica dextra- branch a. gastroduodenalis;

􀀹 a. gastroepiploica sinistra- branch a. lienalis, extending from the celiac trunk, located in lig. gastroliennale.

Codestomach lig. gastroliennale are coming aa. gastricae breves from the splenic artery.

Venous drainage from the stomach is carried out into the portal vein system (v. portae).

Right and left gastric veins (vv. gastricae dextra et sinistra) drain directly into the portal vein.

Left gastroepiploic and short gastric veins (v. gastroepiploica sinistra et vv. gastricae breves) drain into the splenic vein ( v. lienalis), which, in turn, flows into the portal vein.

Right gastroepiploic vein (v. gastroepiploica dextra) drains into the superior mesenteric vein (v. mesenterica superior), also flowing into the portal vein. On the anterior surface of the pylorus at its junction with the duodenum there is v. prepylorica (vein of Mayo), which is an anastomosis between the right gastric and right gastroepiploic veins. During surgical interventions, this vein serves as a guide for finding the border between the pylorus and the duodenum.

Lymphatic drainage from the stomach occurs through lymphatic vessels running near the vessels supplying blood to the stomach, through the 1st and 2nd order lymph nodes.

Regional lymph nodes of the 1st order:

right and left lymph nodes (nodi lymphatici gastrici dextri et sinistri) located in the lesser omentum;

right and left gastroepiploic lymph nodes (nodi lymphatici gastroomentales dextri et sinistri) located in the ligaments of the greater omentum;

---------------- gastro-pancreatic lymph nodes (nodi lymphatici gastro-ncreatici) located in the gastropancreatic ligament.

The 2nd order lymph nodes for the organs of the upper floor of the abdominal cavity are the celiac lymph nodes (nodi lymphatici celiacae).

The vagus nerves innervate the stomach (nn. vagi) and branches of the celiac plexus (plexus celiacus).