Anatomy of the hiatus and abdominal oesophagus

Abstract

In the lower thorax, the oesophagus first lies anteriorly and then anteriorly and to the left of the aorta. It then passes further to the left as it passes through the oesophageal hiatus to join the stomach. The segment of oesophagus that lies in the abdomen during repose is about 3 cm long. However, there is appreciable shortening of the oesophagus during swallowing, belching and vomiting. The abdominal oesophagus is more or less retroperitoneal with peritoneum covering its anterior and left side only. Posteriorly the oesophagus lies on the left hiatal pillar of the left (or right) crus of the diaphragm, which separates it from the aorta. The left lobe of the liver lies anterior to the abdominal oesophagus and to its right lies the caudate lobe. The physical presence of these structures means that the most direct access to the abdominal oesophagus is anterior and left.