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CHAPTER

15

Distal Pancreatectomy

173

Sagittal image of the upper abdomen


Superior epigastric vessels

Falciform
ligament

Transversalis fascia
Parietal peritoneum

Linea alba
Rectus abdominis muscle
Liver
Lesser omentum
Left gastric artery and vein

Visceral peritoneum of liver

7th costal cartilage


External
oblique muscle

Proper hepatic artery (bifurcation)


Costodiaphragmatic
recess of pleural
cavity

Diaphragm
Stomach

Gallbladder
Common hepatic duct
Cystic duct

Gastrosplenic
ligament and
short gastric
vessels

Hepatic
portal vein

Pleura

Intercostal
vessels and
nerve
Omental (epiploic)
foramen (of Winslow)

Spleen

Common
hepatic artery
(retroperitoneal)

Splenorenal ligament
with splenic vessels

Omental bursa
(lesser sac)
Inferior vena cava

Intercostal
muscles

Hepatorenal recess
(Morisons pouch)

Parietal peritoneum
on posterior wall
of omental bursa

Right crus of diaphragm


Azygos vein
Thoracic duct
Right sympathetic trunk
Anterior longitudinal ligament
Celiac ganglia
Abdominal aorta

Latissimus
dorsi muscle
Iliocostalis
Erector spinae
Longissimus muscle
Spinalis
Body of T12 vertebra

CT scan demonstrating solid tumor in the tail of the pancreas

FIGURE 151 Anatomy for preoperative evaluation of pancreas.

Left suprarenal gland


Left kidney

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