The Mobility of the Antrum, Pylorus, Duodenum, and Gall Bladder in Health and Disease: the Influence of Mobility in the Functioning of These Organs in the Biliary Tract

Abstract

IN order to discuss this subject intelligently, it is necessary to give a detailed description of the method of suspension of the organs of the upper right quadrant which permits their mobility, and also, why mobility is necessary for the proper functioning of these organs. The peculiar method of their suspension also explains why these organs can assume such varied locations in the abdomen. It is a matter of everyday observation by roentgenologists and surgeons that the location of the stomach, pylorus, cap, and gall bladder varies with different types of habitus. In the sthenic types, the organs lie high and the gall bladder some distance from the midline; in the asthenic types, the organs lie low and the gall bladder nearer the midline. The gall bladder is attached to the liver and partakes of its mobility. Gray's “Anatomy” states: “The position of the pylorus in the erect living body of the male varies from 14.5 cm. above to 8 cm. below and in the female from 15 cm. above to 2.5 cm. below the interiliac line. The range of position in regard to the sagittal axis of the erect body varies in males from 8.8 cm. to the right to 2 cm. to the left of the axis. In 84 per cent it is to the right of the axis. In females the position ranges from 6 cm. to the right to 2.6 cm. to the left of the sagittal axis. In 89.5 per cent it is to the right. The most common position in both males and females is from 2.5 cm. to 5 cm. to the right.” The first portion of the duodenum or cap is covered by peritoneum and, consequently, is freely movable. It begins at the pylorus and ends at the neck of the gall bladder. Gray's “Anatomy” states: “It is in such close relation to the gall bladder that it is usually found stained by bile after death, especially on its anterior surface.” The stomach is covered with peritoneum anteriorly and posteriorly, thus allowing complete mobility. It is continuous with the esophagus at its upper extremity, and has a fairly rigid attachment at this point. From here, the stomach is suspended to the diaphragm and liver by the lesser omentum. Gray's “Anatomy” describes this attachment as follows: “The lesser omentum (or gastrohepatic omentum) is the duplicature which extends to the liver from the lesser curvature of the stomach and the commencement of the duodenum. It is extremely thin, and is continuous with two layers of peritoneum which cover, respectively, the antero-superior and postero-inferior surfaces of the stomach and first part of the duodenum. When these two layers reach the lesser curvature of the stomach and the upper border of the duodenum, they join together and ascend as a double fold to the porta of the liver; to the left of the porta the fold is attached to the bottom of the fossa for the ductus venosus, along which it is carried to the diaphragm, where the two layers separate to embrace the end of the esophagus.