THE LYMPHATIC VESSELS OF THE ABDOMEN AND PELVIS 793 



the course of the superficial epigastric vessels, and those from the sides of the lum- 

 bar part of the abdominal wall pass along the crest of the ilium, with the super- 

 ficial circumflex iliac vessels. The supe/ricial lymphatic vessels of the gluteal 

 region turn horizontally round the outer side of the buttock, and join the super- 

 ficial inguinal nodes. 



The deep vessels run alongside the principal bloodvessels. Those of the 

 parietes of the pelvis, which accompany the gluteal, sciatic, and obturator vessels, 

 follow the course of the internal iliac artery, and ultimately join the lateral aortic 

 nodes. 



Lymphatic Vessels of the Perineum and External Genitals. The lymphatic vessels 

 of the perineum and of the integument of the penis, and of the scrotum (or 

 vulva), follow the course of the external pudic vessels, and terminate in the 

 superficial inguinal nodes. Those of the glans penis (or glans clitoridis) termi- 

 nate partly in the deep inguinal nodes and partly in the external iliac nodes. 



The visceral nodes are associated with the branches of the coeliac axis, 

 superior and inferior mesenteric arteries. Those related to the branches of the 

 coeliac axis artery form three chains, gastric, hepatic, and splenic, which accom- 

 pany the corresponding branches of the artery. 



The nodes of the gastric chain (lymphoglandulae gastricae superiores) are 

 divisible into three groups viz.: (a) upper gastric, on the stem of the artery; (6) 

 lower gastric, accompanying the descending branches of the artery along the 

 cardiac half of the lesser curvature of the stomach, between the two layers of the 

 small omentum; and (c) paracardial, "outlying members of the coronary chain, 

 disposed in a manner comparable to a chain of beads around the neck of the 

 stomach" (Jamieson and Dobson 1 ). 



The nodes of the gastric chain receive their afferents from the lesser curvature 

 and contiguous surfaces of the stomach; their efferents pass to the coeliac group 

 of preaortic nodes. 



The nodes of the hepatic chain (lymphoglandulae hepaticae) (Fig. 574) consist 

 of the following groups: (a) hepatic, on the stem of the hepatic artery and along 

 the common bile duct, between the two layers of the gastrohepatic omentum 

 as far as the transverse fissure of the liver; the cystic node, a member of this 

 group, is placed near the neck of the gall-bladder; (6) subpyloric, four or five in 

 number, at the bifurcation of the gastroduodenal artery at the angle between the 

 first and second parts of the duodenum; (c) one or two retropyloric nodes along 

 the pyloric artery; (d} right gastroepiploic (lymphoglandulae gastricae inferiores), 

 four to seven in number, between the two layers of the greater omentum, along 

 the pyloric half of the greater curvature of the stomach. The nodes of the 

 hepatic chain receive afferents from the pyloric portion of the stomach, duodenum, 

 liver, gall-bladder, and the head of the pancreas; their efferents pass to the coeliac 

 group of preaortic nodes. 



The splenic nodes (lymphoglandulae pancreaticolienales] accompany the splenic 

 artery and are situated in relation to the dorsal surface and upper border of the 

 pancreas and in the lienorenal ligament. Their afferents are derived from the 

 fundus of the stomach, from the spleen, and from the pancreas; their efferents 

 pass to the cceliac group of preaortic nodes. 



The superior mesenteric nodes comprise three groups mesenteric, ileocolic, 

 and mesocolic. 



The mesenteric nodes (lymphoglandulae mesentericae) (Fig. 572) lie between 

 the layers of the mesentery, and vary from one hundred to one hundred and fifty 

 in number. One set is situated close to the wall of the small intestine, among the 

 terminal twigs of the superior mesenteric artery; a second is in relation with the 



i Lancet, April 20 to 27, 1907. 



