MCQ 17

A 36 yr old woman is hospitalized for treatment of a stomach ulcer that has been getting progressively worse over several months. Radiographic studies reveal the site of involvement to be along the greater curvature, approximately 4 cm away from the pyloric sphincter. That night ulcer perforates, and there is considerable intra abdominal bleeding. Surgery reveals that the ulcer eroded through the stomach wall and has damaged the artery supplying the involved region of the stomach. Which artery was likely involved?

a. Left gastric
b. Left gastroepiploic
c. Right gastric
d. Right gastroepiploic
e. Short gastric

Answer and explanation

The correct answer is 'd'.

The right gastroepiploic artery, off the gastroduodenal artery, supplies the right half of the greater curvature of the stomach and could be directly affected by the ulceration of the greater curvature of the stomach at a site this close(4cm) to the pyloric sphincter.

The left gastric artery (choice a), off the celiac trunck, supplies the left half of the greater curvature of the stomach.

The left gastroepiploic(choice b), off the splenic artery, supplies the left half of the greater curvature of the stomach. Although it anastomoses with the rt gastroepiploic artery, it is unlikely that this artery would be directly damaged by the ulceration of the stomach near the pyloric sphincter.

The rt gastric artery (choice c), off the proper hepatic artery, supplies the right half of the lesser curvature of the stomach.

The short gastric artery (choice e), actually one of the several (4-5) short gastric arteries, off the splenic artery (occasionally left gastroepiploic), supplies the fundus of the stomach, which is the most distant from the pylorus.