Talk:Paper - Transposition of Abdominal Viscera (1926)
Transposition Of Abdominal Viscera
By Proressor N. Pan
Professor of Anatomy, Medical College, Calcutta
Iw an adult female subject brought into the dissecting room of the Medical College, Calcutta, during the winter term of 1923-4, transposition of some of thé abdominal viscera was noticed. As such cases are comparatively rare and as pathological conditions of these transposed organs during life are apt to mislead the clinicians, I am publishing a short account of the peculiarities noted.
Gastro-intestinal Tract. The size of the stomach is small, being 74 inches in length and 24 inches in breadth. The cardiac orifice is situated at the level of the 11th thoracic vertebra on its right side. The left vagus nerve lies in front of and the right vagus nerve behind the cardiac orifice. The pyloric orifice is situated on the left side of the body of the 12th thoracic vertebra. The lesser curvature extending from the left margin of the oesophagus has the concavity directed upwards and to the left and gives attachment to the hepato-gastric ligament. The greater curvature extending from the right margin of the oesophagus is directed at first upwards and to the right, then downwards and forwards and finally downwards and to the left. The antero-superior surface of the stomach is in relation with the inferior surface of the right lobe of the liver, the gall bladder, the quadrate lobe of the liver and the anterior abdominal wall. The antrum cardiacum of the oesophagus grooves the posterior surface of the right lobe of the liver to the left of the fossa for the inferior vena cava.
Duodenum. The duodenum is horseshoe-shaped, with the convexity directed to the left. It is 4 inches in length and situated to the left side of the vertebral column, extending from the left side of the 12th thoracic vertebra to the left side of the body of the 2nd lumbar vertebra. The concavity of the duodenal curve embraces the head of the lower pancreas. The bile duct and the pancreatic ducts open separately on the postero-medial aspect of the duodenum, the opening of the bile duct lying half an inch lateral to the opening of the lower pancreatic duct. The hepato-duodenal ligament is attached to the commencement of the duodenum.
Jejunum and Ileum. The coils of the jejunum and the ileum are chiefly placed on the left side of the abdominal cavity. They measure only 9 feet in length.
Caecum. The caecum is situated in the lower part of the umbilical region .on the right side of the middle line.
Ascending Colon. The ascending colon, 7 inches in length, passes upward and slightly lateralwards towards the spleen, lying in front of the upper limb Transposition of Abdominal Viscera 203
of the transverse colon and right kidney. The upper end of the ascending colon turns backwards and downwards forming the right colic flexure.
Transverse Colon. The transverse colon begins on the right side of the 2nd
lumbar vertebra, passes towards the left in front of the 8rd-lumbar vertebra and forms a bend on the left side of the body of the 4th lumbar vertebra. Then
Impression . “i ee Right Lobe ‘A a Liver ee | a . Duodeno Dorsal PancFeas 3% s , om Pyloric
Caudate Lobe me a 4 ae 2 g Constriction
Spleen is | oS Pyloric
Accessory Spleens hl Large Intestines Hf 47) / intestines
Cecum Appendix Transverse Colon lleo-colic ower fo junction Sigmoid Co lon
Ovary Uterine Tube
Fig. 1. Superficial View
it crosses the middle line to the right in front of the body of the 4th lumbar vertebra, lying below and parallel to the upper limb of the transverse colon. Then it passes upwards and to the right to form the splenic flexure. It has no mesocolon and its anterior surface lies under cover of the coils of the ileum, caecum and the ascending colon. The length of the transverse colon is 18 inches.
- 14-2 204 . NN. Pan
Descending Colon. It passes downwards and medialwards on the right side of the abdomen towards the ala of the sacrum. It measures 8 inches in length.
Sigmoid Colon. It is situated on the right side. It has no mesocolon. It measures 4 inches in length.
Liver. The caudate lobe is very prominent, measuring 2 inches by 1 inch by l inch. It hangs downwards in front of the vertebral column to the left side of the oesophagus above the lesser curvature of the stomach and the lower
Fundus of Stomach Dorsal Pancreas
Ceeliac Art. Pancreatic Duct
Duodeno-Pytoric F Constriction
Lienal Artery Opening of Bile-Duct Opening of Pancreatic-Duct
Common Trunk of Left Gastric and Hepatic Arteries
Acce ssory Spleens A. Spleen
Lienal Flexure Hepatic Flexure Ascending Colon
Descending Colon Trans.Colon
Inferior Vena-Cava Abdominal Aorta Coecum
Lower end of Ileum Appendix
Utrine Tube Uterus
Fig. 2. Deep View, small intestines removed and stomach thrown upwards
pancreas but to the left of the upper pancreas. The inferior surface of the right lobe has the gastric impression but the splenic impression takes the place of the colic and renal impressions. The bare area is very small and the oesophageal impression lies on the posterior surface of the right lobe. The gall bladder lies in the cystic fossa in the right lateral line of the body. The inferior surface of the left lobe of the liver bears the renal impression for the left kidney.
Spleen. It is of a flattened oval shape and is situated in the right hypoTransposition of Abdominal Viscera 205
chondriac region. Its anterior surface is in relation with the inferior surface of the right lobe of the liver, the postero-inferior surface of the stomach and the tail of the lower pancreas. The hilum occupies the lower fourth of the anterior surface near the right lateral border and is so deep as to subdivide partially the spleen into an anterior and a posterior portion. It looks downward and to the right and transmits the branches of the lienal vessels. The posterior surface of the spleen is in relation with the right suprarenal gland and the upper end of the right kidney, and the diaphragm separates it from the 10th and 11th ribs and the 9th and 10th intercostal spaces of the right side. The spleen measures 4 inches in length, 3 inches in breadth and 14 inches in thickness.
Accessory Spleens. There are five accessory spleens, four being situated towards the upper end of the spleen and the fifth one at the lower end. They are all separate from the spleen and are contained between the two layers of the gastro-lienal ligament. Their sizes vary from 3 inch by } inch by } inch to 14 inches by 1 inch by inch.
Pancreas. There are two pancreatic organs, an upper and a lower. The upper pancreas lies obliquely across the vertebral column passing from above downwards and to the left in the epigastric region. Its upper end is on the right side of the body of the 10th thoracic vertebra and its lower end is on the left side of the body of the 11th thoracic vertebra, where it lies in apposition with the head of the lower pancreas. It is prismatic in shape, the upper end being larger than the lower. It measures 3 inches by 1 inch by } inch. Its anterior surface is covered by the peritoneum of the omental bursa. Its posterior surface is uncovered by peritoneum. Its duct opens into the duodenum by a minute orifice separate from and above the orifices of the bile duct and the duct of the lower pancreas. It receives its blood supply from the pancreatic branches of the lienal artery, which arises directly from the front of the abdominal aorta above the origin of the coeliac artery, and passes towards the right below the upper pancreas.
The lower pancreas is larger than the upper pancreas. It measures 4 inches by 1 inch by 4 inch. It is also prismatic in shape. It is placed transversely across the vertebral column in front of the body of the 12th thoracic vertebra. A triangular interval separates its body and tail from the upper pancreas but its head is in close apposition with the lower end of the upper pancreas. It is covered anteriorly by peritoneum but uncovered posteriorly. It is supplied by branches derived from the lienal artery. Its duct begins near the tail on the right side and traverses its substance nearer to its posterior surface and then opens into the duodenum by a separate aperture unconnected with that of the bile duct.
The upper pancreas represents the dorsal pancreas which has failed to fuse with the lower one representing the ventral pancreas.
Abdominal Aorta. It lies in front of the vertebral column on the right side of the inferior vena cava. The following peculiarities are noted about its branches: 206 N. Pan
(1) The lienal artery arises separately and passes towards the right to the hilum of the spleen.
(2) The hepatic, left gastric and superior mesenteric arteries arise by a common trunk—representing the coeliac artery below the lower pancreas and the origin of the lienal artery.
(8) The inferior mesenteric artery passes towards the right.
(4) There are two renal arteries, in the left side of which the lower one passes to the lower end of the left kidney.
Inferior Vena Cava. It is formed by the union of the two common iliac veins in front of the body of the 5th lumbar vertebra behind the left common iliac artery. It ascends on the left side of the abdominal aorta and at the upper part of the abdomen slightly inclines forwards and to the right to reach the taval fossa on the posterior surface of the right lobe of the liver; on entering
he thorax it opens into the right atrium. It receives the usual tributaries but he left ovarian vein opens into it direct and the right ovarian vein opens into the right renal vein.
Uterus and Ovaries. The uterus is retroverted. The ovaries and the fimbriated ends of the uterine tubes are situated in the iliac fossae above the back part of the brim of the pelvis.
There is no transposition of heart or lungs or of the large blood vessels of the thorax.
My thanks are due to Dr Bepin Behari Basak, Demonstrator of Anatomy, for carefully dissecting the abnormalities noted. I thank also Mr Dayanidhi Misra, student of the fourth year class of this College, for making the drawings for me.