Anatomy of the Pharynx and Oesophagus
John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford in Head & Neck Surgery Plastic Surgery, 2018
The abdominal section of the oesophagus is the shortest of the three sections and emerges through the right crus of the diaphragm at the level of the tenth thoracic vertebra, left of the midline. It lies in the oesophageal groove on the posterior aspect of the left lobe of the liver before passing to the left to enter the stomach. The right border of the oesophagus continues into the lesser curvature of the stomach in the shape of a truncated cone to become continuous with the cardiac orifice of the stomach. It is covered with peritoneum overlying the lesser sac. The left border of the oesophagus, however, is separated from the fundus of the stomach by the cardiac notch. It is contained within the superior part of the lesser omentum due to the peritoneal coverings that encompass it on its lateral and anterior aspects. On its posterior surface, peritoneum is reflected to the diaphragm. This is part of the gastrosplenic ligament connecting the stomach and the spleen. The oesophageal branches of the gastric artery travel through this ligament to arrive at the abdominal part of the oesophagus. Even further posteriorly are the left phrenic artery and the left crus of the diaphragm. The vagus nerve travels alongside the oesophagus but its relation to the structure is varied as the oesophagus traverses the diaphragm. The left vagus nerve, with its two to three trunks, is usually located on the anterior aspect. The thick, single right vagus nerve is situated posterior to the oesophagus.
Peritoneal metastases
Anju Sahdev, Sarah J. Vinnicombe in Husband & Reznek's Imaging in Oncology, 2020
Cancers of the stomach, colon, pancreas, liver, gallbladder, spleen, and ovary can invade directly into the adjacent ligaments and mesenteries, and then into connecting organs as well as the gastrointestinal (GI) tract and abdominal wall (5,6). Gastric cancer often spreads into the adjacent gastrohepatic ligament and then may invade into the left lobe of the liver (7). Pancreatic cancer can extend from the retroperitoneum into the hepatoduodenal ligament (which contains the bile duct, hepatic artery, and portal vein) and then into the liver (8). Tumours of the colon, stomach, and pancreas often spread through the transverse mesocolon and greater omentum and can invade the transverse colon. The right side of the transverse mesocolon forms the duodenocolic ligament, providing a direct route for extension of colon cancer from the hepatic flexure to the duodenum (9). The phrenicocolic ligament (which extends from the splenic flexure to the diaphragm) prevents extension of metastases along the left side of the greater omentum. The gastrosplenic ligament extends from the greater curve of the stomach to the spleen and can be involved by extramural spread from gastric cancer. Direct involvement of the small bowel mesentery is commonly seen in carcinoid, pancreatic, breast, and colonic metastases. Lymphoma often spreads from the retroperitoneum through the root of the small bowel mesentery to the small bowel.
The spleen
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
The weight of the normal adult spleen is 75-250 g and it measures up to 10 x 7 x 3 cm. It lies in the left hypochondrium between the gastric fundus and the left hemidiaphragm, with its long axis lying along the 10th rib. The hilum sits in the angle between the stomach and the kidney and is in contact with the tail of the pancreas. The concave visceral surface lies in contact with these structures, and the lower pole extends no further than the mid-axillary line. There is a notch on the inferolateral border, and this may be palpated when the spleen is enlarged. The tortuous splenic artery arises from the coeliac axis, usually from a common stem with a hepatic artery, and runs along the upper border of the body and tail of the pancreas, to which it gives small branches. The short gastric and left gastroepiploic branches pass between the layers of the gastrosplenic ligament. The main splenic artery generally divides into superior and inferior branches, which, in turn, subdivide into several segmental branches (Figure66.1).
Laparoscopic Pancreatectomy in Rats: The Development of an Experimental Model
Published in Journal of Investigative Surgery, 2022
José Marcus Raso Eulálio, Manoel Luiz Ferreira, Paulo César Silva, Juan Miguel Renteria, Andrei Ferreira Costa Nicolau, Thales Penna de Carvalho, Adrielle Rodas Fernandes, Julia Radicetti de Siqueira Paiva e Silva, Alberto Schanaider, José Eduardo Ferreira Manso
Through the laparoscope inserted in the midline trocar it is possible to identify the liver, the small bowel, the stomach, the spleen and the colonic segment adjacent to the greater curvature (Figure 3). The dissector in the right trocar is then inserted between the stomach and the colon. Lifting the stomach away from the colon brings up the pancreatic lobe of the pancreas and reveals the gastrosplenic ligament, an avascular semitransparent membrane. The division of the gastrosplenic ligament with scissors separates the greater curvature of the stomach from the spleen and the from the colon. After this division, the stomach can be pushed over the liver, exposing the underlying splenic lobe of the pancreas and the right kidney (Figure 4). The splenic vessels follow the upper margin of the splenic lobe within the parenchyma, from the mesentery until the hilum, and are not usually visible in most animals.
Infantile Inflammatory Myofibroblastic Tumor of Spleen
Published in Fetal and Pediatric Pathology, 2022
Balamurugan Thirunavukkarasu, Pritam Singha Roy, Kirti Gupta, Aravind Sekar, Deepak Bansal
An 18-month-old girl presented with progressive abdominal distension, pallor and failure to thrive. On examination, she had firm splenomegaly 6 cm below left costal margin. Computed tomography (CT) of abdomen showed a well-defined multilolobulated enhancing mass in the gastrosplenic ligament region that measured 9 × 8×6 cm and extended from left hemidiaphragm to lower pole of spleen. It showed central hypodensity with coarse calcification (Fig. 1A). Grossly, the tumor was grayish-white, firm in consistency with calcification, and infiltrated the spleen (Fig. 1B). Microscopy showed a spindle cell tumor arranged in interlacing fascicles in a variable fibrocollagenous stroma. The tumor margins with spleen were blurred. Tumor cells diffusely extended into the splenic parenchyma (Fig. 1C). The tumor demonstrated mild to moderate pleomorphism with eosinophilic cytoplasm and conspicuous nucleoli. Many scattered plasma cells and mature lymphocytes were present in the background (Fig. 1D). Mitotic figures were occasionally identified. The cells were diffusely positive for smooth muscle actin (SMA) (Fig. 2A) while negative for S-100p, CD117 (not shown). A diagnosis of IMT was made. Workup for ALK-1 (Clone D5F3, Roche Ventana) (Fig. 2B), ROS1 (Clone SP 384, Rabbit Monoclonal Antibody, Roche Ventana) (Fig. 2C), and Epstein–Barr virus (EBV) encoded RNA by immunohistochemistry (EBER ISH) were negative (Fig. 2D). The surgical resection margins were free of tumor. Post-excision, the child is doing well with no relapse at 10 months of follow up.
Related Knowledge Centers
- Peritoneum
- Short Gastric Veins
- Spleen
- Mesentery
- Greater Omentum
- Curvatures of The Stomach
- Short Gastric Arteries
- Left Gastroepiploic Artery
- Left Gastroepiploic Vein
- Major Trauma