Page 88 - Clinical Anatomy

ECA2 7/18/06 6:42 PM Page 73

The gastrointestinal tract 73

drain along the right gastro-epiploic vessels to the subpyloric nodes and
thence to the aortic nodes.
•◊◊Area III — the left one-third of the greater curvature of the stomach
drains along the short gastric and splenic vessels lying in the gastrosplenic
and lienorenal ligaments, then, via the suprapancreatic nodes, to the aortic
group.
This extensive lymphatic drainage and the technical impossibility of its
complete removal is one of the serious problems in dealing with stomach
cancer. Involvement of the nodes along the splenic vessels can be dealt with
by removing spleen, gastrosplenic and lienorenal ligaments and the body
and tail of the pancreas. Lymph nodes among the gastro-epiploic vessels
are removed by excising the greater omentum. However, involvement of
the nodes around the aorta and the head of the pancreas may render the
growth incurable.

The vagal supply to the stomach (Fig. 55)
The anterior and posterior vagi enter the abdomen through the
oesophageal hiatus. The anterior nerve lies close to the stomach wall but
the posterior, and larger, nerve is at a little distance from it. The anterior

Fig. 55◊The vagal supply
to the stomach:
(a) anterior vagus;
(b) posterior vagus.