Regions and functional anatomy
Anatomically, the organ has four key parts:
- Cardia (pars cardiaca) — the initial segment.
- Fundus or fornix (fundus ventriculi / fornix) — the upper part to the left of the cardia, corresponding to the gastric air bubble.
- Body of stomach (corpus ventriculi) — the largest central part.
- Pyloric part (pars pylorica) — the terminal segment transitioning into the duodenum.
According to its clinical function, the living organ is divided into the digestive sac (saccus digestorius), which combines the cardia, fundus, and body, and the evacuation channel (canalis egestorius), which includes the pylorus and pyloric part.
Walls, curvatures, and shape
The organ has an anterior wall (paries anterior), which is more convex, and a posterior wall (paries posterior). The margins are represented by two curvatures:
- Lesser curvature (curvatura ventriculi minor): a short, concave upper margin.
- Greater curvature (curvatura ventriculi major): a long, convex lower margin.
The shape of the organ is extremely variable: an empty stomach looks like a hollow flat organ with opposing walls. X-ray anatomical variants include stocking, hook (or Rieder shape), horn (or Holzknecht shape), age-related variants (spindle-shaped in newborns), and pathological variants («hourglass» stomach, snail-like, and cascade stomach).
Skeletotopy and projection onto the abdominal wall
With moderate filling, the organ is projected onto the epigastric region and left hypochondrium.
- Cardiac orifice: projected at the site of attachment of the left VI–VII rib cartilages to the sternum.
- Exit (pylorus): located 2.0–2.5 cm to the right of the midline at the level of the VIII rib cartilage (shifts to the right up to 3–5 cm upon filling).
- Lesser curvature: covered by the liver, repeating the arched line around the xiphoid process.
- Greater curvature: originates at the V rib along the midclavicular line, runs to the X rib, crosses the rectus abdominis muscle, and ends at the level of the 8th intercostal space beneath the liver.
Relations to the peritoneum and fixing apparatus
The stomach is covered by the peritoneum intraperitoneally (on all sides). The only exceptions are narrow areas of the greater and lesser curvatures, where blood vessels and nerves run, and omental attachments are anchored.
Fixation of the organ is ensured by several factors:
- Fixation of the gastroesophageal junction within the esophageal hiatus of the diaphragm.
- Attachment of the pylorus to the posterior abdominal wall.
- Tone of the abdominal wall and pressure from surrounding organs.
- Ligamentous apparatus, representing derivatives of the primary mesenteries (e.g., hepatogastric and gastrocolic ligaments).
Briefly: answers to topical questions
Which ligaments form the ligamentous apparatus of the stomach?
The ligamentous apparatus of the stomach is formed by derivatives of the primary mesenteries and peritoneal folds. It includes the following ligaments:
- Hepatogastric ligament (lig. hepatogastricum)
- Gastrocolic ligament (lig. gastrocolicum)
- Gastrosplenic ligament (lig. gastrolienale / lig. gastrosplenicum) — connects the greater curvature with the hilum of the spleen.
- Gastropancreatic ligament
- Pyloric-pancreatic ligament
- Phrenicoesophageal ligament
Which organs are in contact with the posterior wall of the stomach?
The posterior wall of the stomach (paries posterior) is in contact with the pancreas. According to topographic relations, the pancreas lies posterior to the stomach, with the posterior wall of the stomach separated from the anterior surface of the pancreas by the cavity of the omental bursa. No other organs in direct contact with the posterior wall of the stomach are mentioned in the sources.
Which arteries supply blood to the stomach along the lesser and greater curvatures?
Blood supply to the stomach along the lesser and greater curvatures comes from the celiac trunk system via the formation of arterial arcades.
- Along the lesser curvature: an anastomotic arcade is formed by branches of the left gastric artery (a. gastrica sinistra) and the right gastric artery (a. gastrica dextra).
- Along the greater curvature: the arterial arcade is formed by an anastomosis between the left gastro-epiploic artery (a. gastroepiploica sinistra) and the right gastro-epiploic artery (a. gastroepiploica dextra).
Additionally, short gastric arteries (aa. gastricae breves) supply the fundus of the stomach.
Where does lymph drain from the various parts of the stomach?
Lymph from the stomach drains into regional lymph nodes of the first and second order. Celiac lymph nodes (nodi lymphatici coeliaci) are the main second-order regional nodes for the stomach. From there, lymph drains into aortic and caval lymph nodes. Efferent vessels of the stomach and liver may drain into the same regional nodes.
What is the innervation of the stomach?
The stomach is innervated by the autonomic nervous system, which includes parasympathetic and sympathetic fibers.
- Parasympathetic innervation: is provided by the vagus nerves (n. vagus). The left vagus nerve forms the anterior trunk (truncus vagalis anterior) on the anterior surface, and the right forms the posterior trunk (truncus vagalis posterior) on the posterior surface. The posterior trunk gives off Latarjet's nerve to the pyloroantral region.
- Sympathetic innervation: is carried out by branches of the celiac plexus and its derivatives (superior and inferior gastric, hepatic, splenic, and superior mesenteric plexuses).
Additionally, branches of the phrenicoabdominal nerves participate in innervation.
To memorize the boundaries: the cardia is fixed at the 6th–7th ribs on the left (like the heart, situated higher), while the pylorus is located 2 cm to the right of the midline at the level of the 8th rib.
Class and exam questions
What is the peritoneal relation of the stomach?
The stomach is covered by peritoneum intraperitoneally, i.e., on all sides. Only narrow strips along the lesser and greater curvatures remain uncovered.
What is Traube's space?
This is a semilunar area in the left hypochondrium that corresponds to the fundus of the stomach and contains the gas bubble.
What parts of the stomach are distinguished radiologically?
In a living person, a digestive sac (cardia, fundus, and body) and an evacuation channel (pyloric part and pylorus) are distinguished.
What else to study on this topic
- Anatomy of the ligamentous apparatus (mesenteric derivatives)
- Blood supply and venous drainage of the stomach
- Lymphatic system and regional lymph nodes
- Organ innervation (vagus and sympathetic nerves)
- Topography of the omental bursa and the posterior wall of the stomach
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Other topics in the section "Topographic Anatomy of the Abdomen"
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