The Pyloric Sphincteric Cylinder in Health and Disease



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Chapter 7 (page 28)

Discussion

Investigators differ on the question of continuity of gastric and duodenal lymphatics. According to Jamieson and Dobson (l907), who injected lymph plexuses in the gastric submucosa, free communication existed between gastric and duodenal submucosal lymphatics; this was also the view of Coller et al. (l941). Horton (l928, l931) and Williams (l962) on the other hand, during injections of India ink into the gastric submucosal space, found a complete block at the pylorus, with no communication between gastric and duodenal submucosal lymphatics. The differing results could be due to differences in methodology; whereas Jamieson and Dobson (l907) injected lymphatic plexuses, it seems that the injections of Horton (l928, l931) and Williams (l962) were done into the submucosal space.

According to Jamieson and Dobson (l907) the gastric and duodenal subserous lymphatics did not communicate, while Horton (l928, l931) found that they were continuous. All authors agree that the gastric submucous and gastric subserous lymphatic systems communicate freely. There is general agreement about extramural lymphatic drainage away from the stomach. These factors are of importance in the spread of gastric carcinoma, and especially when spread of pyloric carcinoma into the duodenum has to be considered (Chap. 33).

The findings of Eker (l951) show that extramural lymphatic drainage from the region of the pyloric sphincteric cylinder is downwards, to the suprapyloric and subpyloric glands.

Lehnert et al. (l985) thought that the low incidence of lymph node metastasis in early gastric carcinoma, where the lesion is confined to the mucosa, could be due to the rarity of lymph capillaries (as opposed to blood capillaries) in the mucosa.

References

  1. Coller FA, Kay EB, McIntyre RS. Regional lymphatic metastases of carcinoma of the stomach. Arch Surg l941, 43, 748-761.
  2. Cunningham DJ. Text-book of Anatomy. Edit Brash JC, Jamieson EB. Oxford Univ Press, 8th ed, London l947, p 1457.
  3. Eker R. Carcinomas of the stomach: investigation of the lymphatic spread from gastric carcinomas after total and partial gastrectomy. Acta Chir Scand l951, 101, 112-126.
  4. Horton BT. Pyloric musculature, with special reference to pyloric block. Amer J Anat l928, 41, 197-225.
  5. Horton BT. Pyloric block with special reference to the musculature, myenteric plexus and lymphatic vessels. Arch Surg l931, 22, 438-462.
  6. Jamieson JK, Dobson JF. The lymphatic system of the stomach. Lancet l907, l, l061-l066.
  7. Last RJ. Anatomy: Regional and Applied. Churchill Livingstone, 7th ed, London l984, p 280.
  8. Lehnert T, Erlandson RA, Decosse JJ. Lymph and blood capillaries of the human gastric mucosa: a morphologic basis for metastasis in early gastric carcinoma. Gastroenterology l985, 89, 939-950.
  9. Menguy R. Surgery of Peptic Ulcer. WB Saunders Co, Philadelphia l976, p 4.
  10. Moore KL. Clinically Oriented Anatomy. Williams Wilkins Co, Baltimore l980, p 176.
  11. Williams I. Closure of the pylorus. Brit J Rad l962, 35, 653-670.


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