460 ABDOMEN 



the blood-vessels which lie behind the posterior wall of the upper part of 

 the omental bursa. Remove also the medial layer of the gastro - lienal 

 ligament, and the medial layer of the lieno-renal ligament. The object of 

 this dissection 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 cceliac ganglion and the left great splanchnic nerve ; (5) the 

 upper part of the abdominal portion of the aorta ; (6) the cceliac artery 

 and its branches, 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 termination of the cceliac 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 

 pancreas, 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 pancreatico-gastric 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 pancreatico-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 gives off a number of small, gastric branches, and the 

 left gastro-epiploic artery, which run forwards to the stomach, along the left 

 layer of the gastro-lienal ligament, which is also still in position. Note, 

 further, that the splenic artery breaks up into branches before it reaches 

 the spleen. In many cases the small 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 

 pancreatico-gastric fold, to the junction of the oesophagus with the stomach, 

 where the artery gives off its cesophageal 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 cceliac 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 

 cceliac ganglion, which is connected with the plexus of nerves round 

 the root of the cceliac artery. Follow the ganglion upwards and back- 

 wards to its union with the left great 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, immediately above the level of the 

 cceliac artery, trace each medially to the aorta, and laterally across the 

 surface of the corresponding crus ; note that the left passes behind the 

 oesophagus ; the right passes behind the inferior vena cava, although this 

 fact cannot be demonstrated until a later period. Clean the posterior 

 surface of the abdominal part of the oesophagus and secure the right vagus 



