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Chapter 18: Stomach

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Which of the following statements concerning vascular anatomy of the stomach is most accurate?

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(A) The left gastric artery mainly supplies the greater curvature of the stomach.

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(B) Occlusion of the left gastroepiploic and left gastric arteries is likely to result in clinically significant gastric ischemia.

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(C) Bleeding gastric ulcers are often the result of posterior erosion into the gastroduodenal artery.

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(D) Both the short gastric arteries and the left gastroepiploic artery arise from the splenic artery in the majority of patients.

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(D) The stomach is supplied by a rich anastomotic network of both intramural and extramural arteries. The majority of the blood supply derives from the celiac trunk via the left gastric artery (Fig. 18-3). The lesser curvature of the stomach is perfused by the left gastric artery (a branch of the celiac artery) and the right gastric artery (a branch from either the hepatic artery or the gastroduodenal artery). The greater curvature is perfused by the gastroepiploic arteries: The left gastroepiploic and short gastric arteries branch from the splenic artery, while the right gastroepiploic artery derives most often from the gastroduodenal artery with a small contribution from the superior mesenteric artery (A incorrect). In most individuals, the left gastroepiploic artery forms an anastomosis with the right gastroepiploic artery, forming an arcade along the greater curvature. Due to the extensive system of arterial anastomoses, the stomach can withstand occlusion or disruption to several supplying branches. It is routine to ligate the left gastric and the left gastroepiploic arteries when using the stomach to replace a resected esophagus, leaving the right gastoepiploic artery as the main vessel to perfuse the mobilized stomach in the chest, with a smaller contribution by the right gastric artery (B incorrect).

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Image not available.

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FIGURE 18-3. Arterial supply of the stomach (from Zollinger RM Jr, Ellison E, Bitans M, Smith J, eds. Zollinger’s Atlas of Surgical Operations. New York, NY: McGraw-Hill; 2011: Plate 1, Fig. 1. Copyright © The McGraw-Hill Companies, Inc. All rights reserved).

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Erosion of a gastric ulcer into the gastroduodenal artery is uncommon. Massive hemorrhage secondary to a duodenal ulcer is often the result of erosion into the gastroduodenal artery, which is positioned immediately posterior to the first portion of the duodenum (C incorrect).

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BIBLIOGRAPHY

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Mahvi DM, Krantz SB. Stomach. In: Townsend CM, Beauchamp RD, Evers BM, et al., eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:1182–1226.

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Mulholland MW. Gastric anatomy and physiology. In: Greenfield LJ, Mulholland MW, Oldham KT, Zelenock GB, Lillemoe KD, eds. Greenfield’s Surgery: Scientific Principles and Practice. ...

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