 Good day everybody. This is Dr. Sajya Sanyal, Professor Department Chair. This is Subhain Kedavar. I'm demonstrating from the right side and I'm holding the camera. This is going to be a dissection and demonstration of the deep epigastric region. Therefore, we have removed the stomach, we have removed the small intestine and we have removed the large intestine from here. So to bring you up to speed, we have here in front of us, this is the sea loop of the diodenum that we can see here. Stuck inside the sea loop of the diodenum, this is the pancreas. Straight away you would have noticed something, you will notice that this whole portion is completely black. Apparently this Kedavar during life had suffered from necrotizing pancreatitis. This is the inferior part of the liver and we have reflected up the lesser momentum here. So this structure that I have lifted up here, this is the cut portion of the first part of the diodenum. The first inch of the first part of the diodenum is intraperitoneal. The rest of the diodenum is retroperitoneal. So this is the supia part of the diodenum. This is the descending part of the diodenum. This is the transverse part of the diodenum and it goes under the supia mesentric muscles and this is the ascending part of the diodenum. And this is the DJF flexure and from here it becomes intraperitoneal as the gigenum. So these are the parts of the diodenum that we can see here. Now let's take a look at the pancreas here. Inside the sea loop of the diodenum, we have the head of the pancreas which I said is completely necrosed before we cannot make out much of it. After the head of the pancreas, the next structure that we can see part of the pancreas is this one which I have elevated up here. This is the neck of the pancreas. Then we have the body of the pancreas. And to trace the body of the pancreas, it goes and the tail of the pancreas is attached to the hilum of the spleen. And we can see a little bit of the hilum of the spleen next to the artery forceps there. The pancreas is slightly oblique. The head is in the region of L3 and the tail is in the region of L1. So this is the location of the pancreas. Now let's take a look at the neurovascular structures that we can see here in this relationship. We can see this vessel here. This is the celiac trunk. And from the celiac trunk we can see this artery coming out. This is the common hepatic artery. The second largest branch. And we can see the common hepatic artery is making a bend up. And in the place where it is making a bend, this is giving this branch here. And this branch is the gastrodural artery which runs behind the first part of the diurnum. Then after that the hepatic artery becomes the known as the hepatic artery proper. This gastrodural artery as it runs behind the first part of the diurnum which I have reflected back. It can get perforated in a posterior penetrating diurnal ulcer and can produce severe hematomasis which can be life threatening. This gastrodural artery is giving this branch here. This is the right gastropyloic. And accompanying this, this is the right gastropyloic vein which is opening into the supramacentric vein. To come back to the celiac trunk we have the next branch here. This is largest branch of the celiac trunk. That is the sprenic artery. The sprenic artery runs along the superior border of the pancreas. And it is notoriously tortuous and we can see it is highly tortuous. That is because it forms a part of the bed of the stomach and it is tortuosity compensates for the movement of the stomach. This sprenic artery apart from supplying the spleen, it also gives branches to the stomach to the pancreas and it also gives vasobrivia. It also gives the left gastropyloic which we can see here. To continue we have this smallest branch of the celiac trunk that is the gastric artery which runs on the lesser curvature of the stomach. Now let's come down below the pancreas. We can see this vein here. This is the supramacentric vein. And this is next to that. To the left of that is the supramacentric artery. The supramacentric artery is the artery of the mid-gut. Let's take a look at what happens to the supramacentric vein. The supramacentric vein unites under the neck of the pancreas. It unites with this vein that we can see here. This is the sprenic vein. And after that it forms the portal vein which runs in the portal triad, extrapatic portal triad. In this particular cadaver we notice something unique. This is the inframacentric vein which runs in the paradodional fossa. And the inframacentric vein ideally is supposed to open into the sprenic vein. But in this case it opens into the supramacentric vein. Having mentioned these, now let's come to the extrapatic portal triad itself. I have reflected back the diodenum in its normal location. And my instrument has gone under the extrapatic portal triad. This is the location of the extrapatic portal triad. My instrument is under the extrapatic portal triad. So what are the three structures that we can see here? We can see the hepatic artery proper here. Deep inside we can see the portal vein. And we can see the common bile duct. So these are the structures which were enclosed in the two layers of the hepatic diodenal ligament which we have removed. And they go to the hilum of the liver and the liver is above my instrument. So these are all the structures that we can see here. We cannot see any other blood vessel at the pancreatic or diodenal junction because of the necrotizing pancreatitis. But at this juncture I can mention one important clinical correlation pertaining to the pancreatic or diodenal region. The answer of the head of the pancreas will require an extensive surgery called Wipel's procedure or pancreatic or diodenectomy. Where this entire segment has to be removed because the head of the pancreas is intimately related anatomically and vascular wise to the sea loop of the diodenum. So these are all the structures that I wanted to show you in the deep epigastric region after removing the stomach. Thank you very much Dr. Sanjay Sanyal signing out. If you have any questions or comments please put them in the comment section below. Have a nice day.