THE CONTENTS OF THE ABDOMEN. 129 



stomach is consequently not in immediate contact with the anterior abdominal wall (Plate n); 

 somewhat downward and to the left, however, there is a typically formed triangular area of the 

 gastric surface which rests against the inner surface of the abdominal wall. It is bounded to the 

 right by the inferior margin of the liver, to the left by the eighth to the tenth costal cartilages, and 

 below by the transverse colon. It is in this situation that gastrotomy may most easily be per- 

 formed for the establishment of a fistula or for the removal of a foreign body. Beneath the costal 

 margin in the left hypochondriac region the stomach is covered not only by the ribs and intercostal 

 muscles, but also by the left lung, by the left pleural cavity, and by the diaphragm, so that pene- 

 trating wounds in this region may injure the pleura, the lung, and the stomach, and the gastric 

 contents may escape into the pleural cavity. The so-called space of Traube is situated in the left 

 hypochondriac region and represents that portion of the stomach which is not covered by the 

 neighboring viscera (Plate 13, left illustration, and Plate n). It is bounded above and to 

 the left by the inferior margin of the left lung, above and to the right by the inferior margin 

 of the left lobe of the liver, below and to the right by the costal margin, and posteriorly and 

 to the left by the spleen. 



The posterior surface of the stomach borders upon the bursa omentalis (Figs. 60 and 62) 

 which separates it from the anterior surface of the pancreas, the facies gastrica of the spleen, the 

 duodenojejunal flexure, and the upper portion of the anterior surface of the kidney. 



For clinical purposes it is important to remember that the normal stomach is separated 

 anteriorly and posteriorly from the neighboring organs by capillary spaces, but in such a manner 

 that a direct relation and contact is a possible and more or less frequent occurrence during life. 

 In this manner may be explained the adhesions between the stomach and neighboring organs and 

 their manifold sequelae in cases of gastric ulcer. After adhesions with the pancreas and to the 

 splenic vessels running along its upper border, a fatal hematemesis may occur from the perfora- 

 tion of the splenic artery by a gastric ulcer. A similar ulcer may become adherent to the trans- 

 verse colon and perforate into this portion of the intestine, so that there is a direct communication 

 between the stomach and the colon; the stomach may adhere to the diaphragm and the gastric 

 ulcer may perforate into the pleural or into the pericardial cavity. If the lung has become adhe- 

 rent to the upper surface of the diaphragm, the inflammatory process will spread to the lungs 

 and the bronchi and the gastric contents may gain access to the bronchi and be coughed up. If 

 the anterior surface of the stomach contracts adhesions with the inner surface of the abdominal 

 wall, it is possible for the inflammation to extend to the abdominal wall and end in external per- 

 foration. 



The arteries of the stomach all arise from the celiac axis, the first of the three single branches 

 of the abdominal aorta. (Where does the abdominal aorta begin and where does it end ? What 

 are the names of the four paired parietal branches and of the three single and three paired vis- 

 ceral branches ?) The celiac axis arises from the anterior surface of the aorta just below the 

 aortic opening in the diaphragm (Fig. 61) and immediately divides into three branches, the gas- 

 tric, the hepatic, and the splenic arteries. The gastric artery (A. gastrica sinistra) runs from the 

 left to the right along the lesser curvature at the attachment of the lesser omentum. The hepatic 

 artery gives off the second of the two arteries of the lesser curvature, the pyloric (A. gastrica 

 dextra), which passes to the left from the pylorus and anastomoses with the gastric artery. The 

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