298 ABDOMEN 



is to display (i) the anterior surface of the body, the neck, 

 and part of the head of the pancreas ; (2) a part of the anterior 

 surface of the left kidney ; (3) the anterior surface of the left 

 suprarenal gland ; (4) the left coeliac ganglion and the left 

 greater splanchnic nerve ; (5) the upper part of the abdominal 

 portion of the aorta ; (6) the coeliac artery and its branches, viz. 

 the hepatic, the splenic, and the left gastric artery and their 

 branches ; (7) the inferior phrenic arteries ; (8) the upper parts 

 of the crura of the diaphragm ; (9) the terminal part of the 

 right vagus nerve. 



Clean the pancreas first, and do not disturb it from its 

 position. At the upper border of the pancreas, in the median 

 plane, and below the caudate lobe of the liver, find the coeliac 

 artery, dividing into its three terminal branches : the hepatic, 

 running to the right ; the splenic, to the left along the upper 

 border, or immediately behind the upper border, of the pancre'as , 

 and the left gastric, running upwards and to the left to the junction 

 of the oesophagus with the stomach. Trace the first portion of the 

 hepatic artery, through the right gastro-pancreatic fold, to the right 

 free margin of the omentum, where it has already been exposed, 

 and, if possible, preserve the sympathetic nerve filaments which 

 surround it. Secure its gastro- duodenal branch, which descends 

 behind the first part of the duodenum and in front of the neck 

 of the pancreas, and trace it to its division into the superior pan- 

 creatico- duodenal and the right gastro-epiploic arteries. Trace the 

 latter to the left to the point where the stomach was divided. 

 Trace the splenic artery to the left, to the anterior surface of the 

 left kidney, and then forwards, along the left layer of the lieno- 

 renal ligament, which is still in situ, to the spleen, and note 

 that before it reaches the spleen it g^ves off a number of short 

 gastric branches, and the left gastro - epiploic artery, which 

 run forwards to the stomach, along the left layer of the gastro- 

 splenic ligament, which also is still in position. Note, further, 

 that the splenic artery breaks up into branches before it reaches 

 the spleen. In many cases the short gastric branches and the 

 left gastro-epiploic artery spring from the terminal branches, and 

 not from the trunk of the splenic artery. Secure also the 

 branches from the splenic artery to the pancreas, and, if possible, 

 preserve the sympathetic nerve plexus which surrounds the 

 artery. Follow the left gastric artery, through the left gastro- 

 pancreatic fold, to the junction of the oesophagus with the 

 stomach, where the artery gives off its oesophageal branch or 

 branches ; secure also the accompanying vein, the coronary 

 vein of the stomach, and trace it, across the median plane, to 

 its union with the portal vein at the lower end of the right free 

 margin of the lesser omentum. Trace the coeliac artery back- 

 wards to its origin from the front of the aorta, and do not injure 

 the plexus of sympathetic nerve filaments which surrounds it. 



Immediately to the left of the cceliac artery, and at the upper 

 border of the pancreas, find the left coeliac ganglion, which is 

 connected with the plexus of nerves round the root of the cceliac 

 artery. Follow the ganglion upwards and backwards to its union 

 with the left greater splanchnic nerve. Immediately to the left 

 of the ganglion find the left suprarenal gland, and, below it, the 

 upper and medial part of the anterior surface of the left kidney. 



Find the inferior phrenic arteries, one on each side, immedi- 



