title: Earlobe-like peritoneal appendage near the angle of His: a useful landmark for demarcating the lateral margin of the gastric cardia.
abstract: The gastric cardia-the small area around the cardiac orifice including the abdominal esophagus-is an important target area for abdominal and thoracic surgeries, especially for laparoscopic procedures. In this study of 28 cadavers, a peritoneal earlobe-like appendage near the angle of His was identified as a useful indicator of the lateral margin of the abdominal esophagus, which is otherwise obscure because the peritoneum continues to the diaphragm without definite demarcation of this margin. This structure, which appears equivalent to the epiploic appendages, was commonly found to be present (in 22/28, 78.6 % of the 28 cadavers) and was 4-21 mm × 6-40 mm × 1-4 mm in size, triangular, round, or leaf-like in shape, contained fat, and was on an imaginary line along which the lesser omentum adheres to the lesser curvature and continues to the diaphragm (18/22, 81.8 %). This indicator is associated with the lesser omentum and is part of the gastrophrenic ligament, and could serve as a useful indicator of the margin of the gastric cardia, thus aiding surgeons performing laparoscopic surgery in this region.
authors.affiliation: Department of Histology and Embryology, Shinshu University School of Medicine, Matsumoto, Nagano, 390-8621, Japan. 14mh034a@shinshu-u.ac.jp.
authors.forename: Kanji
authors.initials: K
authors.lastname: Hirashima
authors.affiliation: Department of Histology and Embryology, Shinshu University School of Medicine, Matsumoto, Nagano, 390-8621, Japan.
authors.forename: Fengming
authors.initials: F
authors.lastname: Yue
authors.affiliation: Department of Histology and Embryology, Shinshu University School of Medicine, Matsumoto, Nagano, 390-8621, Japan.
authors.forename: Daihachiro
authors.initials: D
authors.lastname: Tomotsune
authors.affiliation: Department of Histology and Embryology, Shinshu University School of Medicine, Matsumoto, Nagano, 390-8621, Japan.
authors.forename: Katsunori
authors.initials: K
authors.lastname: Sasaki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002299:Cardia / Q000033:anatomy & histology*; D003964:Diaphragm / Q000033:anatomy & histology; D004947:Esophagus / Q000033:anatomy & histology; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D009852:Omentum / Q000033:anatomy & histology; D010537:Peritoneum / Q000033:anatomy & histology
keywords: Abdominal esophagus; Gastric cardia; Laparoscopic surgery; Lesser omentum; Peritoneal earlobe-like appendage