Document Detail

Anatomical investigation of the esophageal and aortic hiatuses: physiologic, clinical and surgical considerations.
MedLine Citation:
PMID:  15088789     Owner:  NLM     Status:  MEDLINE    
Precise knowledge about the anatomical constitution of the diaphragmatic pillars is essential to understand the physiologic, clinical and surgical roles of the esophageal and aortic hiatuses. Because anatomical descriptions found in the literature are dubious, we have decided to investigate this subject. Anatomical dissections and histologic sections of the right and left diaphragmatic pillars (diaphragma crura) from 43 human bodies were analyzed, comprising both non-fixed and fixed specimens. We have described a classification of the diaphragmatic pillars and their muscular branches, forming two basic arrangements (patterns I and II) around the esophageal and aortic hiatuses. Such anatomical and functional relationships between the esophagus and its diaphragmatic hiatus help explain why, during normal inspiration, a hiatal enlargement is observed first but is followed, thereafter, during deep inspiration, by a hiatal narrowing exerted by the contraction of the diaphragmatic pillars. Our results also show that the aortic hiatus does not seem to constitute a rigid ventral tendinous arc around the aorta that could impose any considerable degree of vascular compression, as suggested by other investigators. The present study provides anatomical data useful for a better understanding of gastroesophageal reflux physiology, antireflux surgery and abdominal angina.
Milton Melciades Barbosa Costa; Mario Ary Pires-Neto
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Anatomical science international     Volume:  79     ISSN:  1447-6959     ISO Abbreviation:  Anat Sci Int     Publication Date:  2004 Mar 
Date Detail:
Created Date:  2004-04-19     Completed Date:  2004-06-08     Revised Date:  2011-02-08    
Medline Journal Info:
Nlm Unique ID:  101154140     Medline TA:  Anat Sci Int     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  21-31     Citation Subset:  IM    
Departamento de Anatomia of the Instituto de Ciências Biomédicas, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
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MeSH Terms
Aorta / anatomy & histology*,  physiology
Diaphragm / anatomy & histology*,  physiology
Esophagus / anatomy & histology*,  physiology
Gastroesophageal Reflux / pathology,  physiopathology
Hernia, Hiatal / pathology,  physiopathology
Medical Illustration
Respiratory Physiological Phenomena
Tendons / physiology

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