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Stomach Microcirculation
Published in John H. Barker, Gary L. Anderson, Michael D. Menger, Clinically Applied Microcirculation Research, 2019
The blood supply of the stomach is particularly rich (Figure 1). Six arteries provide the main blood supply: the left and right gastric arteries supply the area of the lesser curvature, the right and left gastroepiploic arteries supply the area of the greater curvature, the splenic artery via short gastric arteries (vasa brevia) supply the area of the fundus, and the gastroduodenal artery sends branches to the pylorus.1–3
Stomach and duodenum
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
The stomach has an arterial supply on both lesser and greater curves (Figure63.1). On the lesser curve, the left gastric artery, a branch of the coeliac axis, forms an anastomotic arcade with the right gastric artery, which arises from the common hepatic artery. Branches of the left gastric artery pass up towards the cardia. The gastroduodenal artery, which is also a branch of the hepatic artery, passes behind the first part of the duodenum, highly relevant with respect to the bleeding duodenal ulcer. Here it divides into the superior pancreaticoduodenal artery and the right gastroepiploic artery. The superior pancreaticoduodenal artery supplies the duodenum and pancreatic head, and forms an anastomosis with the inferior pancreaticoduodenal artery, a branch of the superior mesenteric artery. The right gastroepiploic artery runs along the greater curvature of the stomach, eventually forming an anastomosis with the left gastroepiploic artery, a branch of the splenic artery. This vascular arcade, important for the construction of the gastric conduit in oesophageal resection, is often variably incomplete. The fundus of the stomach is supplied by the vasa brevia (or short gastric arteries), which arise from near the termination of the splenic artery.
Gastrointestinal surgery in gynecologic oncology
Published in J. Richard Smith, Giuseppe Del Priore, Robert L. Coleman, John M. Monaghan, An Atlas of Gynecologic Oncology, 2018
Eileen M. Segreti, Stephanie Munns, Charles M. Levenback
The blood supply to the stomach is derived from the celiac trunk. The greater curvature of the stomach is supplied by the right and left gastroepiploic arteries. The lesser curvature is supplied by the right and left gastric arteries. The right gastric artery and the right gastroepiploic artery are branches of the common hepatic artery and gastroduodenal artery, respectively. The left gastric artery is a branch of the celiac trunk, and the left gastroepiploic artery is a branch of the splenic artery. Routes of venous drainage include the gastric and gastroepiploic veins as well as small tributaries of the esophageal veins.
Factors for unsuccessful endoscopic hemostasis in patients with severe peptic ulcer bleeding
Published in Scandinavian Journal of Gastroenterology, 2021
Yo Kubota, Hiroshi Yamauchi, Kento Nakatani, Tomohisa Iwai, Kenji Ishido, Tomonari Masuda, Takaaki Maruhashi, Satoshi Tanabe
Thomopoulos et al. reported that among 427 cases of peptic ulcer bleeding, spurting hemorrhage (OR, 2.45; 95% CI, 1.51–3.98) and ulcer hemorrhage of the posterior wall of the duodenal bulb (OR 2.48; 95% CI, 1.37–7.01) were predictors of unsuccessful endoscopic hemostasis [24]. In addition, duodenal ulcers with active bleeding have been reported to be poor prognostic factors and rebleeding factors [25–27]. Our study had similar results to these reports. The reason for this factor may be that the lumen of the duodenum is narrow, which limits endoscopic manipulation; the duodenum is associated with major blood vessels, such as the gastroduodenal artery, which may cause massive bleeding, and during active bleeding, blood easily fills the lumen, making it difficult to secure a visual field.
Dieulafoy lesions and gastrointestinal bleeding
Published in Baylor University Medical Center Proceedings, 2020
Carissa Teresa Rodriguez, Joseph Scott H. Bittle, Thomas James Kwarcinski, Selina Juarez, Jonathan Robert Hinshelwood
A 70-year-old woman with no contributory past medical history presented to the emergency department with dyspnea. On computed tomography angiography (CTA), a submucosal gastric vascular structure was incidentally noted (Figure 1a). Outpatient esophagogastroduodenoscopy confirmed a nonulcerated, serpiginous, submucosal vascular structure within the distal antrum, consistent with a gastric Dieulafoy lesion (Figure 1b). Interventional radiology was consulted for a mesenteric angiogram with possible intervention. After catheterization of the right common femoral artery, a 5 French reverse curve catheter was used to engage the celiac trunk. Selective angiography demonstrated the Dieulafoy lesion arising from a small branch of the gastroduodenal artery, and a 2.4 French steerable microcatheter was coaxially used to catheterize the gastroduodenal artery branch (Figure 1c, 1d). Due to the distal location and multiple feeding vessels, the decision was made to use Onyx (ethylene vinyl alcohol copolymer) for embolization, allowing for the ability to reflux the permanent embolization agent into the numerous feeding vessels. In this situation, coils or glue (N-butyl-2 cyanoacrylate) would likely be less effective. Coils would need to be placed both distal and proximal to the lesion to prevent backfilling. Glue requires a short injection duration due to the immediate reaction to blood, which would require the catheter to be closer to the lesion. Postprocedural CTA of the abdomen and pelvis confirmed successful embolization without evidence of residual filling (Figure 1e).
Cephalic pancreaticoduodenectomy with preservation of a right coronary artery bypass graft using the right gastro-epiploic artery: a case report
Published in Acta Chirurgica Belgica, 2019
K. Homsy, J.-L. Paquay, H. Farghadani
The procedure began by an abdominal exploration through a bi-subcostal laparotomy confirming a pulsating right gastro-epiploic artery. The artery was found running anterior to the left hepatic lobe, through a diaphragmatic hiatus reaching the pericardial space. A clamping test of the gastroduodenal and right gastro-epiploic artery confirmed myocardial tolerance to short-term ischemia. After a Kocher manoeuver in order to evaluate the resectability of the tumor, priority was given to isolating the right gastro-epiploic artery. The common hepatic artery as well as the gastroduodenal artery was isolated. The gastro-duodenal artery was clamped and ligated at its origin allowing the section of the vessel. The right gastro-epiploic artery was removed from its origin and an end-to-end re-implantation to the origin of the gastroduodenal artery was made using an 8/0 polypropylene monofilament running suture. With cardiac revascularization restored, a regular cephalic pancreaticoduodenectomy was performed with no complications. Extended lymphadenectomy around the hepatic pedicle, and interaortocaval region was made. Digestive reconstruction was performed by pancreaticojejunostomy, hepaticojejunostomy and gastrojejunostomy using a ‘Roux-en-Y’ anastomosis.