This is an operative image during laparoscopic surgery for hiatal hernia. What is the structure in this image referred to it by an arrow? Is it thoracic duct or another structure?
Philippe Guillem, thanks for your answer but it seems like a lymphatic structure
so : the cisterna chyli (or cysterna chyli, receptaculum chyli) of course
Really it is difficult to consider it as cisterna chyli. This structure was easily dissected and separated away from the esophagus. I ask if it is lymph node or not? but the answer by Philippe Guillem as (epiphrenic diverticulum) is more accurate. Mostly, it is a traction diverticulum descends from the intrathoracic esophagus to appear in the abdomen.
If it felt lymphatic, couldn't it be a lymph node? I find large nodes there every once in a while.
Could you kindly clarify. I an unable to discern an arrow in this image. Thank you.
Thank you.
It looks like the posterior vagus attached to the esophagus in its proximal course, then dissected away from the esophagus above the arrow (near the plastic tube). The distal part looks like perineural tissue that is distended with oedematous fluid and/or lymph.
Well. If it is not affect thr operation itsbetternot to disect it..keep lion sleep.
Nashwan Qahtan Mahgoob You are right, but the dissection was limited to the upper part adherent to the esophageal wall, which was dissected carefully and separated away from the esophagus with no damage. No dissection was done for the lower part
I think it is the right vagus nerve, surrounded by edematized lymphatic tissue, secondary to gastroesophageal reflux.
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