The stomach is the widest part of the alimentary canal. It is a sac-like
structure that is continuous proximally with the abdominal oesophagus
and distally with the duodenum. The stomach is ensleeved in peritoneum.
The proximal and distal ends of the stomach are relatively immobile due
to their fixity to nearby structures. Elsewhere the stomach shows appreciable
mobility. The principal functions of the stomach are (i) to act as
a receptacle and reservoir for ingested food and to release the food
into the duodenum in small and physiologically appropriate amounts;
(ii) to secrete hydrochloric acid and proteolytic enzymes that initiate protein
digestion and neutralize many harmful bacteria in the ingested food;
and (iii) to churn the ingested food and soften it by means of gastric juice
to produce a liquefied mixture termed chyme.
Embryologically the stomach is derived entirely from the foregut and
this is reflected in its blood supply coming wholly from the coeliac axis.
The past two decades have seen a dramatic decline in the need for surgical
intervention in acid-peptic disease. This has been due largely to the
advent of proton-pump inhibitors and to the discovery of a medically
treatable microbial cause for most cases of peptic ulcer disease. In the
present day, operations for gastric neoplastic disease and bariatric surgery
collectively account for most of the major gastric surgical procedures
in adults.
This article describes in detail the surgically-relevant topographical
anatomy of the stomach including its blood supply and lymphatic
drainage.