The left gastro-omental artery, also known as the left gastroepiploic artery, is a significant branch of the splenic artery. It runs along the greater curvature of the stomach, providing blood supply to the stomach and the greater omentum.
Location
The left gastro-omental artery originates from the splenic artery near the hilum of the spleen. It travels along the greater curvature of the stomach from left to right, within the gastrocolic ligament, and courses through the greater omentum, a fatty apron-like structure that hangs down from the stomach.[1] As it travels, it anastomoses with the right gastro-omental artery, a branch of the gastroduodenal artery, ensuring a continuous blood supply to the greater curvature of the stomach and the greater omentum. This artery lies within the peritoneal cavity and is closely related to the stomach, omentum, and transverse colon.
Anatomy
Origin
The left gastro-omental artery, also known as the left gastroepiploic artery, originates from the splenic artery, typically near the hilum of the spleen. It arises as a terminal branch of the splenic artery after the splenic artery has given off several branches to the spleen, pancreas, and short gastric arteries.
Course
After its origin from the splenic artery, the left gastro-omental artery descends along the greater curvature of the stomach. It travels within the gastrocolic ligament, which is a part of the greater omentum connecting the greater curvature of the stomach to the transverse colon.[8] The artery runs from left to right, following the curvature of the stomach, and provides branches to the stomach wall as it proceeds toward the right side.
Branches
As the left gastro-omental artery courses along the greater curvature of the stomach, it gives off several smaller branches that supply different regions:
- Gastric Branches: These small branches arise along the length of the artery and supply the outer (serosal) layers of the stomach’s greater curvature. They help nourish the muscular and mucosal layers of the stomach.
- Omental Branches: The left gastro-omental artery also sends small branches to the greater omentum, the fatty tissue extending from the stomach. These branches supply the fatty tissue, blood vessels, and lymphatics within the omentum.
Anastomosis
One of the key features of the left gastro-omental artery is its anastomosis with the right gastro-omental artery, which arises from the gastroduodenal artery, a branch of the common hepatic artery.[7] This anastomosis occurs along the greater curvature of the stomach and ensures that the entire greater curvature receives a consistent blood supply from both the left and right gastro-omental arteries.
The anastomosis is functionally significant because it provides redundancy in blood flow, ensuring that the stomach maintains an adequate blood supply even if one of the arteries is compromised. This network also supplies the greater omentum.
Relations
- Anteriorly: The left gastro-omental artery lies in close relation to the anterior surface of the greater curvature of the stomach. It runs between the layers of the peritoneum, which cover the stomach and form the gastrocolic ligament.
- Posteriorly: Posterior to the artery lies the pancreas and the left kidney in its upper part. The artery is separated from these structures by the stomach itself and the layers of the peritoneum.
- Superiorly: Above the left gastro-omental artery is the greater curvature of the stomach and its connection with the gastric fundus. The short gastric arteries, which also arise from the splenic artery, supply this region and are positioned near the left gastro-omental artery.
- Inferiorly: Below the artery lies the greater omentum, which hangs from the stomach and extends over the intestines. The artery sends omental branches to supply the fat and connective tissue within the omentum.
Length and Diameter
The left gastro-omental artery is a relatively long vessel as it spans the distance from the splenic hilum along the greater curvature of the stomach to the point where it anastomoses with the right gastro-omental artery.[6] The length of the artery can vary depending on individual anatomy, but it typically measures about 10–15 cm in length. Its diameter is smaller compared to the splenic artery but sufficient to supply the stomach and omentum effectively.
Termination
The left gastro-omental artery terminates by anastomosing with the right gastro-omental artery near the midpoint of the greater curvature of the stomach. The two arteries form a continuous arterial loop, ensuring that the greater curvature and omentum are fully supplied with blood.
Anatomical Variations
- Variations in Origin: In rare cases, the left gastro-omental artery may have variations in its point of origin. It typically arises from the splenic artery, but in some individuals, it may branch off earlier or closer to the body of the spleen.
- Branching Pattern: The branching pattern of the artery can also vary. Some individuals may have more or fewer gastric or omental branches, or the anastomosis with the right gastro-omental artery may occur at a slightly different point along the greater curvature of the stomach.
Function
The left gastro-omental artery, also known as the left gastroepiploic artery, plays a crucial role in supplying blood to the stomach’s greater curvature and the greater omentum. Its function ensures proper nourishment and metabolic support for these regions, allowing them to perform their respective physiological tasks. Below is a detailed description of the artery’s function based on the areas it supplies.
Blood Supply to the Stomach
The left gastro-omental artery is responsible for providing blood to the greater curvature of the stomach, which is important for:
- Maintaining Gastric Mucosal Health: The gastric branches of the left gastro-omental artery nourish the layers of the stomach wall, particularly the mucosal and muscular layers. These layers are essential for the secretion of mucus and bicarbonate, which protect the stomach lining from the acidic gastric juices.[4] The artery ensures that these tissues receive a continuous supply of oxygen and nutrients, which helps maintain the integrity of the stomach wall.
- Supporting Gastric Muscle Function: The smooth muscle cells in the stomach wall rely on a rich blood supply for energy to perform peristalsis, which is the coordinated contraction of muscles that helps mix and move food through the stomach. The left gastro-omental artery supports this process by providing oxygen and nutrients to these muscle layers.
- Aiding in Digestion: The stomach’s primary role is to digest food by breaking it down with gastric acid and digestive enzymes. The left gastro-omental artery ensures that the stomach’s secretory and muscular activities are well-supported, facilitating proper digestion and the subsequent passage of food into the small intestine.
Blood Supply to the Greater Omentum
The left gastro-omental artery sends small branches to the greater omentum, a large apron-like fold of peritoneum that hangs down from the greater curvature of the stomach. This blood supply is crucial for:
- Nourishing the Omental Tissue: The omentum is composed of fat, blood vessels, and lymphatic tissue. The omental branches of the left gastro-omental artery provide oxygen and nutrients to support the metabolic needs of these tissues, maintaining the structure and function of the omentum.
- Supporting Immune Function: The greater omentum plays a role in immune defense by housing immune cells such as macrophages and lymphocytes.[3] These immune cells help detect and respond to infections or injuries within the abdominal cavity. The blood supplied by the left gastro-omental artery supports the activity of these immune cells, ensuring that the omentum can fulfill its immune role effectively.
- Providing Insulation and Fat Storage: The omentum also serves as a storage site for fat and plays a role in insulating the abdominal organs. The blood flow provided by the artery helps maintain the health of the fatty tissue, which supports these physiological roles.
Contribution to Gastric Anastomotic Circulation
The left gastro-omental artery contributes to the anastomotic network along the greater curvature of the stomach. Its role in collateral circulation is important for:
- Ensuring Continuous Blood Flow to the Stomach: The left gastro-omental artery anastomoses with the right gastro-omental artery (a branch of the gastroduodenal artery) along the greater curvature of the stomach. This anastomotic network ensures that the entire greater curvature of the stomach receives a continuous blood supply from both the left and right gastro-omental arteries. If one artery becomes compromised, the other can provide blood to the affected area, reducing the risk of ischemia.
- Protecting the Stomach During Surgery: This anastomotic circulation is particularly important during surgical procedures, such as gastrectomy or omental resections. By forming an arterial loop, the left and right gastro-omental arteries provide redundant blood flow that can protect the stomach from ischemic injury during or after surgery.
Oxygen and Nutrient Delivery
Like all arteries, the left gastro-omental artery’s primary function is to deliver oxygen and nutrients to the tissues it supplies.[2] This process is essential for:
- Cellular Metabolism: The cells in the stomach and omentum require a constant supply of oxygen and nutrients to carry out their metabolic processes, including energy production, cell growth, and repair. The artery provides this essential supply, ensuring the health and functionality of the tissues in the regions it serves.
- Tissue Repair and Maintenance: The stomach and omentum are subject to constant wear and tear due to their roles in digestion and immune function. The blood supplied by the left gastro-omental artery helps facilitate the rapid repair and regeneration of damaged or stressed tissues, especially in the gastric mucosa, which is exposed to the acidic environment of the stomach.
Clinical Significance
The left gastro-omental artery is clinically significant due to its role in supplying blood to the greater curvature of the stomach and the greater omentum. During gastric surgeries, such as partial or total gastrectomy, preserving the artery and its anastomosis with the right gastro-omental artery is essential to maintain adequate blood flow to the stomach and prevent ischemia. This artery is also involved in surgeries related to the omentum, which may be mobilized during procedures such as omentectomy or for covering exposed abdominal organs in reconstructive surgeries.
In cases of gastric cancer, the left gastro-omental artery may need to be carefully navigated or ligated during tumor resections.[1] Additionally, the artery can be involved in traumatic injuries to the abdomen, where rupture or damage can lead to significant bleeding within the peritoneal cavity. Its robust anastomotic network also provides a safeguard against ischemic damage to the stomach during vascular occlusion or surgical interventions.
