Anatomy of the Stomach and Surrounding Structures, Part I: For Those Who Seek Theoretical Basis Through Understanding of Developmental Process

Abstract

This chapter describes the anatomy of the stomach, the pivotal organ in the upper abdomen, and surrounding structures based on the author’s embryological understanding. The intestinal primordium consists of the foregut, midgut, and hindgut. The stomach and proximal duodenum arise from the foregut. The gastrointestinal tract is anchored to the body wall by the mesentery, as are the stomach and duodenum. The stomach has the dorsal mesogastrium, as its main mesentery, and the ventral mesogastrium, which are both supplied by the celiac artery. Following rotation of the stomach and rotation of the midgut, the two major events during fetal life, these two mesenteries are significantly deformed, distended, anchored, and fused with adjacent mesenteries. The pancreas arises from the duodenal wall and extends through the mesoduodenum into the dorsal mesogastrium. The pancreas is therefore embedded in the mesentery. The principal concept behind gastric cancer surgery is to resect the mesogastrium while sparing the pancreas. A full understanding of the contour of the mesogastrium is therefore important to performing a reasonable operation.