Left and right gastric on the lesser curve, left and right gastro-omental on the greater curve, plus short gastrics
Mnemonic
“Two curves, four arteries, all from the coeliac trunk”:
- Lesser curve - left gastric (from the coeliac) meeting the right gastric (from the hepatic)
- Greater curve - left gastroepiploic (from the splenic) meeting the right gastroepiploic (from the gastroduodenal)
- Fundus - short gastric arteries, from the splenic
“Left before right on both curves”, since the left vessels are the larger and arise more directly from the coeliac axis.
Two clinical consequences: the stomach’s rich anastomosis means it survives ligation of most of its supply, which is what makes gastric pull-up possible after oesophagectomy; and a posterior duodenal ulcer erodes the gastroduodenal artery, while a lesser curve gastric ulcer erodes the left gastric.
Expansion
Lesser curvature
- Left gastric - direct from the coeliac trunk
- Right gastric - from the proper hepatic (or common hepatic) artery
Greater curvature
- Left gastro-omental (gastroepiploic) - from the splenic artery
- Right gastro-omental - from the gastroduodenal artery
Fundus
- Short gastric arteries - from the splenic artery
The anastomosis is so rich that the stomach can survive on a single artery, which is what makes gastric mobilisation for oesophageal replacement possible.
Two bleeding points are worth knowing. A posterior duodenal ulcer erodes the gastroduodenal artery; a lesser curve gastric ulcer erodes the left gastric artery. Both cause torrential haematemesis.