282 ABDOMEN 



The portion of liver removed must be carefully preserved 

 so that it may afterwards be re-attached to the right lobe. 



Omentum Minus. The lesser omentum is a fold of 

 peritoneum which connects the lesser curvature of the 

 stomach and the first part of the duodenum with the 

 margins of the porta hepatis (O.T. transverse fissure) on 

 the inferior surface of the liver, and with the bottom 

 of the fossa for the ductus venosus on the posterior surface. 

 Its left and lower margin is attached to the stomach 

 and duodenum ; its upper margin is attached to the liver ; 

 its right border is free and forms the anterior boundary of 

 an aperture, called the foramen epiploicum (O.T. foramen of 

 Winslow), which connects the cavity of the larger part of 

 the peritoneal sac, called the great sac, with the smaller part, 

 which is termed the omental bursa. The guide to the epiploic 

 foramen is the gall-bladder. If the dissector passes his index 

 finger upwards and backwards along the lower surface of the 

 gall-bladder to its neck, and then turns it backwards and to 

 the left, he will find that it passes through the epiploic 

 foramen into the omental bursa. 



The lesser omentum contains a large number of important 

 structures between its two layers, viz. two of the arteries 

 which supply the stomach ; the hepatic artery and the 

 portal vein, which carry blood to the liver ; the bile ducts, 

 through which the bile is conducted to the duodenum ; and 

 numerous nerves, lymph vessels, and lymph glands. The 

 dissector should now display the structures in the lesser 

 omentum by removing portions of the anterior layer of the 

 fold. It is not probable that he will be able to remove it in 

 a continuous sheet ; but he must take care not to destroy the 

 posterior layer. 



Dissection. Commence at the upper border of the stomach, 

 immediately below the oesophagus. Cut through the anterior 

 layer of the lesser omentum and expose the left gastric artery ; 

 follow the artery downwards to its anastomosis with the right 

 gastric branch of the hepatic artery, and upwards to the point 

 at which it gives off its oesophageal branch ; trace the latter 

 along the oesophagus to the diaphragm. Remove the peri- 

 toneum from the front of the oesophagus and find the left vagus 

 nerve, which descends on the front of the lower end of the 

 oesophagus. Trace the terminal branches of the nerve to the 

 wall of the stomach and into the lesser omentum. Whilst 

 cleaning the left gastric artery the dissector may possibly see 

 some of the anterior left gastric lymph glands at the upper 

 extremity of the lesser curvature. Trace the right gastric 



