Stomach and duodenum
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
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.
Use of the stomach as an esophageal substitute
Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson in Operative Thoracic Surgery, 2017
The third vessel of the celiac trunk, the common hepatic artery, turns to the right, in the direction of the hepatoduodenal ligament of the small omentum. There it divides into the hepatic and gastroduodenal arteries. The hepatic artery runs through the hepatoduodenal ligament to the liver and usually gives rise to the right gastric artery, which proceeds to the lesser curvature of the stomach. The right gastric artery may also originate from the gastroduodenal artery. The gastroduodenal artery runs posterior to the superior part of the duodenum distal to the pylorus and comes out caudad to the duodenum, where it divides into the right gastroepiploic and superior pancreaticoduodenal arteries. All gastric arteries anastomose between themselves directly or indirectly by intramural or extramural branches. Therefore, the ligation of two or even three gastric arteries preserves the blood supply of the stomach under normal circumstances.
Mesenteric and renal angiography
Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead in Cardiovascular Catheterization and Intervention, 2017
The mesenteric arteries arise from the anterior aspect of the lower thoracic and abdominal aorta. These vessels—the celiac trunk, superior mesenteric artery (SMA), and inferior mesenteric artery (IMA)—are responsible for the blood supply to all organs located within the abdominal cavity. The celiac trunk is the first major branch of the abdominal aorta and is an essential source of blood supply to the liver, stomach, and parts of the esophagus, spleen, duodenum, and pancreas. Its origin from the anterior aorta is typically midline at the level of the T12 vertebral body, and it courses inferiorly for 1-2 cm before branching into the left gastric, common hepatic, and splenic arteries (Figure 24.1). The common hepatic artery divides into the proper hepatic artery and, typically, also the gastroduodenal artery. The proper hepatic gives off the right gastric artery before branching into the right and left hepatic arteries. The gastroduodenal artery then goes on to divide into the right gastroepiploic artery and the anterior and posterior superior pancreaticoduodenal arteries. The right gastroepiploic artery and the left gastroepiploic artery (from the splenic artery) join together along the greater curvature of the stomach. The right gastric artery and the left gastric artery join together to run along the lesser curvature of the stomach. Because of the redundant blood supply to the stomach, gastric ischemia is uncommon.
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.
Variations in the vascular and biliary structures of the liver: a comprehensive anatomical study
Published in Acta Chirurgica Belgica, 2018
Burak Veli Ülger, Eyüp Savaş Hatipoğlu, Özgür Ertuğrul, Mehmet Cudi Tuncer, Cihan Akgül Özmen, Mesut Gül
We did not find any Michels type 10 variation. We found 10 (5%) other variants (Michels type 11). In one case, the coeliac trunk and superior mesenteric artery emerged together from the aorta and subsequently separated (Figure 10). In five cases, the common hepatic artery originated directly from the aorta (Figure 11). In one such case, the proper hepatic artery originated from the superior mesenteric artery and the gastroduodenal artery originated directly from the coeliac trunk. Thus, there was no common hepatic artery (Figure 12). In three other cases, the arteries feeding the right lobe of the liver, the right branches of the proper hepatic artery, originated from the coeliac trunk. The common hepatic artery later divided into the left branch of the proper hepatic artery and the gastroduodenal artery (Figure 13). The frequencies of arterial variations are summarized in Table 4.
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.
Related Knowledge Centers
- Anatomy
- Common Hepatic Artery
- Pylorus
- Abdomen
- Stomach
- Blood Vessel
- Duodenum
- Celiac Artery
- Superior Pancreaticoduodenal Artery
- Hepatic Artery Proper