Anatomy of the stomach

The stomach is the widest part of the alimentary canal. Continuous proximally with the abdominal oesophagus and distally with the duodenum, the stomach is ensleeved in peritoneum. The principal functions of the stomach are: (i) to act as a receptacle and reservoir for ingested food and to release the food into the duodenum in small and physiologically appropriate amounts; (ii) to secrete hydrochloric acid and proteolytic enzymes that initiate protein digestion and neutralize harmful bacteria in the ingested food; and (iii) to churn the ingested food and soften it with the help of gastric juice to produce a liquefied mixture termed chyme. Embryologically, the stomach is derived entirely from the foregut and this is reflected in the stomach deriving its blood supply wholly from the coeliac axis. The past two decades have seen a dramatic decline in the need for surgical intervention in acid-peptic disease in the developed world. This has been due largely to the advent of proton-pump inhibitors and to the discovery of a medically treatable microbial cause for most cases of peptic ulcer disease. In the present day, operations for gastric neoplastic disease and bariatric surgery collectively account for most of the major gastric surgical procedures in adults. This article describes in detail the surgically relevant topographical anatomy of the stomach, including its blood supply and lymphatic drainage.