International Journal of Research in Medical Sciences

Yesupadam K et al. Int J Res Med Sci. 2016 Aug;4(8):3473-3478

www.msjonline.org

pISSN 2320-6071 | eISSN 2320-6012

Research Article

DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20162315

A cadaveric study for structural variations of the stomach

K. Yesupadam1*, K. V. N. Geetha Devi2, V. V. V. Lakshmi3

1Department of Anatomy, Guntur Medical College, Guntur, Andhra Pradesh, India

2Department of Anatomy, ACSR Government Medical College, Nellore, Andhra Pradesh, India

3Department of Anatomy, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India

Received: 17 June 2016

Accepted: 08 July 2016

*Correspondence:

Dr. K. V. N. Geetha Devi,

E-mail: geethadevi297@gmail.com

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: The morphology of the stomach taken for the study for its clinical interventions like gastro-oesophagial reflux disorders (GERD) which are very common nowadays because of unusual timing of eating food, stress related jobs, eating of junk foods etc. The obesity now considered to be the 2nd leading cause of death, which can be prevented by gastric reconstructive procedures i.e., the bariatric surgeries.

Methods: The study includes 70 adult cadavers, 28 obtained from the formalin fixed specimens kept for anatomy dissection for 1st year MBBS students from 2009 batch to 2015 batch. The remaining 42 specimens obtained from the postpartum bodies in the Forensic department of Guntur Medical College, Guntur. The abdominal cavity opened according to the incisions in the Cunninghams manual of anatomy. Stomach identified by reflecting anterior abdominal wall. Location noted, shape observed, Length taken, relations blood supply noted, results tabulated.

Results: 71.4% specimens are “J” shaped, 14.2% are reverse “L” shaped, 7.2% are cresentic shaped, 7.2% are cylindrical shaped observed. The length is more in “J” shaped specimens. The lower extent of greater curvature at L3 in 71.4% specimens, at L2 in 21.4% specimens, at L4 in 7.2% specimens.

Conclusions: The present study discussed about the shape of the stomach and the majority of specimens shown “J” shape. Remaining are reverse “L” shape; cresentic and cylindrical shaped.

Keywords: Stomach, “J” shape, Reverse “L” shape, Cresentic shape, Cylindrical shape

INTRODUCTION

The stomach is the most dilated part of the digestive tube and intervenes between Oesophagus and the first part of the duodenum. The stomach acts as a reservoir of food, converts the food into chyme by churning movements and allows the digestion of proteins in to peptones and proteases under influence of hydrochloric acid.

The stomach also secretes abundant mucus which act as a protective barrier of mucous membrane. The mucosa of stomach allows some absorption of water, glucose, alcohol and some salts. The stomach secrete a hormone gastrin which regulates the secretion of pepsin and Hcl. An intrinsic factor is eloberated for the absorption of B12 vitamin in the small intestine.1 The stomach is situated in the epigastrium, left hypochondrium and umbilical regions.2 The stomach is a muscular bag relatively fixed at both ends, mobile else-where. The main parts of stomach are fundus, body and pylorus, with greater and lesser curvatures forming left and right borders with the attachment of greater and lesser omentum respectively.3

In most of the people the stomach is “J” shaped. It receives rich arterial supply from the all three branches of coeliac trunk. Left and right gastric arteries anastomose in the lesser curvature. Right and left gastro epiploic arteries anastomose in the inferior part of greater curvature. The veins drains into the corresponding named vessels which drain in to portal vein. The stomach is also having rich lymphatic plexus mainly drains into pancreatico-splenic and pyloric nodes. Stomach receives parasympathetic innervations through anterior and posterior vagal trunks. Sympathetic fibres reach the stomach through the celiac plexus.4

The shape of stomach Ernest. W. April described that when it is empty appears tubular or “J” shape expect for the bulge of fundus.5 William Montagna stated that the identification of stomach is not based upon the shape (or) location but on type of epithelium and glands it contain, the lining epithelium is simple columnar epithelium forms the cardiac, fundic and pyloric glands. The glands secrete gastric juices which contain gastrin hormone, mucus, pepsin and hydrochloric acid and an intrinsic factor is eloberated successfully which are useful for digestion of food.6 Ranganathan TS described the shape of stomach is pear shaped.7

Existance of gastric ulceration was acknowledged by Dioeles of carystus – 350 BC, Celsus and Galen. Marcellus Donatus in- 1586 first described gastric ulcer at autopsy. Morgagni described both gastric and duodenal ulcers at autopsy in the year 1737. Sidney Jones – 1875 done first feeding gastrostomy. Billroth was the first surgeon successfully resected the distal stomach (gastroduodenectomy). Hirsprung wrote first complete description of congenital hypertrophic pyloric stenosis. Ramsted described operation to alleviate CHPS.8 Correa HWP studied developments of gastric cancers over past decade.9 Gupta JP, Jain AK et al studied about the gastroscopic cytology and biopsies in diagnosis of gastric malignancies.10

Nasogastric intubation is a routine procedure to decompress the stomach in abdominal surgeries, for stomach wash and for feeding purposes. The excess collection of gas in fundus causes pressure on heart which mimic angina. The body of the stomach is used for classical anterior (or) posterior gastro jejunostomy.

Pyloric antrum is the commonest site for gastritis, peptic ulcers and cancer. Incompetance of pyloric spincter results in severe gastro duodenal reflux. Because of extensive extramuraland intramural anastomosis, the erosion of gastric ulcer (or) gastric cancer to the perigastric vessels leads to life threatening haemorrhage. Use of barium in evaluation of disorders of upper GIT. Current status discussed by Opden – Orth J.O.11

With the recent advances in the diagnostic techniques we can study in detail about the pathological conditions of stomach i.e., ultrasonography, fibro optic endoscopy, computerized tomography (CT Scan), magnetic resonance imaging (MRI) and positron emission tomography scanning (PET Scan). The basic anatomical knowledge regarding stomach is essential for inter pretations in diagnostic procedures new chemotherapy strategies for cancers coined by Kubota T.12

METHODS

The present study conducted in adult cadavers ; 28 were obtained from the embalmed cadavers which are placed for dissections in the Department of Anatomy Guntur Medical College, Guntur for 1st year MBBS Students during the years 2008-09 to 2014-15, and 42 specimens were obtained from the postmartum bodies in the Department of forensic medicine, Guntur medical college, Guntur. Out of 70 cadavers 50 are males and 20 are females.

A vertical midline incision from xiphisternum to pubic symphysis and two horizontal incisions along the costal margin and along the inguinal ligament given according to Cunninghams manual of anatomy. The layers of anterior abdominal wall reflected to expose the stomach. The stomach identified, location observed. Shape of stomach noted and recorded. The length is measured and noted, relations with the surrounding structures observed. The lower extent of greater curvature observed and noted. Variations observed.

RESULTS

For the shape of stomach

Out of 70 specimens 50 are “J” shaped, 10 are reverse “L” shape, 5 are cresentic and the remaining 5 are cylindrical.

Figure 1: “J” shaped stomach.
Figure 1: “J” shaped stomach.
Figure 2: Reverse “L” shape stomach.
Figure 2: Reverse “L” shape stomach.

For the length

In the “J” shaped stomachs the length is more, and the length is less in cresentic stomachs. The length varies between 9 -11 inches in J shaped specimens, 9-10 inches in reverse “L” specimens, 8-9 inches in cylindrical specimens, 7-8 inches in cresentic specimens.

The average length in J shaped stomach is 10 inches and the average width is 5 inches. The all specimens situated according to description of authors. The specimens extended between cardiac orifice to pyloric orifices. The extent of greater curvature at the level of L3 in 50 specimens, at the level of L2 in 15 specimens, and at the level of L 4 in 5 specimens.

Figure 3: Cylindrical shape stomach.
Figure 3: Cylindrical shape stomach.
Figure 4: Crescentic shape stomach.
Figure 4: Crescentic shape stomach.
Table 1: Shapes of stomach.
Table reproduced from source PDF page 3, part 1 of 3
Table reproduced from source PDF page 3, part 2 of 3
Table reproduced from source PDF page 4, part 3 of 3
Table 2: Length of stomach.
Table reproduced from source PDF page 4, part 1 of 2
Table reproduced from source PDF page 4, part 2 of 2
Table 3: Extent of greater curvature.
Table reproduced from source PDF page 4, part 1 of 2
Table reproduced from source PDF page 5, part 2 of 2
Table 4: Showing shapes and lengths.
Table reproduced from source PDF page 5

DISCUSSION

The location of stomach lies in the epigastric, left hypochondirc and umbilical regions of abdomen, it extends between lower end of Oesophagus and 1st part of duodenum, was described by the authors in Gray’s anatomy, Grant’s anatomy, last’s anatomy Hollinshed WH anatomy and Ranganathan TS anatomy. The present study coincides with the authors 100%.

The shape of the stomach described by majority of authors as “J” shape. Ranganathan TS described as pear shaped structure.

In the Calanders surgical anatomy the shape of stomach is given as cornucopia. In present study 71.4% stomachs are J shaped; 14.2% are reverse “L” shaped; 7.2% are cylindrical and 7.2% are crescentic shaped which coincides with the Calanders description.

CONCLUSION

The majority of specimens are “J” shaped. The length of J shaped stomachs are more when compared with cresentic shaped stomach. The extent of greater curvature at different levels. In 71.4% specimens are at the levels of L3; 21.4% specimens are at the level of L2 and the remaining 7.2% at the L4.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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