The Lymph Glands and Vessels of the Abdomen and Pelvis

The lymph glands of the abdomen consist of two main groups, parietal and visceral. The parietal glands lie in the subperitoneal or subcutaneous tissue; they receive the lymph vessels from the abdominal and pelvic walls, from parts of the viscera, and from the proximal lymph glands of the pelvic limbs. The visceral glands lie on the walls of the viscera or in the peritoneal folds which connect the organs with the wall or with adjacent viscera. They receive all or most of the lymph vessels from the organs with which they are connected.

The parietal glands comprise the following:

1. The lumbar lymph glands (Lg. lumbales) lie along the course of the abdominal aorta and posterior vena cava (Fig. ). Some are placed along the lower surface and sides of the vessels, others above. A few small glands may be found above the sublumbar muscles. The small nodes which are situated at the hilus of the kidneys are often termed the renal lymph glands. They receive afferent vessels from the lumbar wall of the abdomen and the paired viscera (kidneys, adrenals, genital organs), also the inguinal vessels and the efferents of the iliac glands. Their efferents go to the thoracic duct, constituting the lumbar trunks of origin of that vessel.

2. The internal iliac lymph glands (Lg. iliacæ internæ) are grouped about the terminal part of the aorta and the origins of the iliac arteries (Fig. ). Their afferent vessels come chiefly from the pelvis, pelvic viscera, and tail, and they receive efferent vessels of the external iliac and deep inguinal glands.

3. The external iliac lymph glands (Lg. iliacæ externæ) form a group on either side on the iliac fascia at the bifurcation of the circumflex iliac artery (Fig. ). Their afferent vessels come from the flank and abdominal floor, the outer surface of the thigh, and the precrural glands. The efferent vessels go to the lumbar and internal iliac glands.

4. The sacral lymph glands (Lg. sacrales) are small nodes situated along the borders of the sacrum and on its pelvic surface. They receive afferents from the roof of the pelvis and from the tail, and their efferent vessels pass to the internal iliac glands.

5. The superficial inguinal lymph glands (Lg. inguinales superficiales) lie on the abdominal tunic in front of the external inguinal ring (Fig. ). They form an elongated group along the course of the subcutaneous abdominal artery, on either side of the penis in the male, above the mammary glands in the female; in the latter they are often termed mammary. Their afferents come from the inner surface of the thigh, the abdominal floor, the sheath and scrotum in the male, and the mammary glands in the female. The efferent vessels ascend through the inguinal canal and go to the deep inguinal and lumbar glands.

6. The ischiatic lymph gland (Lg. ischiadica) is a small node which may be found at the lesser sciatic notch. It receives lymph from the adjacent parts and from the popliteal glands, and sends efferents to the sacral and internal iliac glands.

The visceral glands include the following:

1. The gastric lymph glands (Lg. gastricæ) are situated along the course of the gastric arteries. Several occur along the attachment of the gastro-phrenic ligament. A group lies at the lesser curvature a short distance below the cardia. There is another small group on the visceral surface where the posterior gastric artery divides into its primary branches. Two or three small nodes are usually found on the ventral aspect of the pylorus. Other small glands are scattered along the course of the gastro-epiploic and short gastric arteries in the great and gastro-splenic omenta. The efferent vessels pass largely to the cœliac radicle of the thoracic duct, but along the left part of the great curvature they go to the splenic glands.

2. The hepatic lymph glands (Lg. hepaticæ) lie along the portal vein and hepatic artery and in the lesser omentum. Their efferent vessels go to the cœliac radicle of the cisterna chyli.

Many of the lymph vessels from the parietal surface of the liver pass in the falciform and lateral ligaments to the diaphragm and anastomose with its lymphatics. Some pass through the diaphragm with the vena cava and go to the mediastinal glands.

The pancreatic lymph vessels follow the course of the blood-vessels which supply the gland; most of them go to the splenic and hepatic glands.

3. The splenic lymph glands (Lg. lienales) lie along the course of the splenic blood-vessels. Their afferent vessels come from the subscapular network of the spleen, from the greater curvature of the stomach, and from the left part of the pancreas. The efferents pass to the cœliac radicle of the thoracic duct.

4. The mesenteric lymph glands (Lg. mesentericæ) are situated in the great mesentery near its root. They are numerous and hence lie close together. They receive a very large number of afferent vessels (400 to 500) from the small intestine. They have several considerable efferents which concur in the formation of the intestinal radicles of the cisterna chyli.

The lymph vessels of the intestine form three sets of capillary plexuses, viz., in the subserosa, submucosa, and mucosa. The lymph follicles, solitary and aggregate, lie in the zone of the plexus of the mucosa. The collecting vessels arise from the subserous plexus.

5. The lymph glands of the cæcum are numerous and are distributed along the course of the cæcal blood-vessels. Their efferents enter into the formation of an intestinal radicle of the cisterna chyli.

6. The lymph glands of the great colon are extremely numerous and are placed close together along the colic blood-vessels. Their efferent vessels are large and numerous. They converge to two large trunks which concur with those of the cæcum and small intestine to form an intestinal radicle of the cisterna chyli.

The intestinal radicles of the cisterna chyli are formed by the confluence of efferents from the intestinal lymph glands. The anterior trunk lies on the left side of the anterior mesenteric artery, passes between that vessel and the cœliac artery, turns sharply backward across the right renal vessels and opens into the cisterna. It is formed by the union of the cœliac trunk with efferents from the glands of the small intestine, cæcum and colon. It is about four inches (ca. 10 cm.) in length and is ampullate. The posterior trunk receives vessels from the small intestine and small colon. It usually opens into a trunk formed by the union of the right and left lumbar ducts. It is usually ampullate at its termination (Franck). The arrangement of these collecting trunks is, however, very variable.

7. The lymph glands of the small colon are situated in part on the wall of the bowel along the attachment of the mesentery, in part between the layers of the latter along the course of the blood-vessels. The efferent vessels go to the lumbar glands and to the posterior intestinal radicle of the thoracic duct.

The lymph vessels of the rectum pass chiefly to the lumbar and internal iliac glands.

8. The anal lymph glands (Lg. anales) form a small group on either side of the sphincter ani externus (Figs. , ). They receive afferents from the anus, perineum, and tail. Their efferents go to the internal iliac glands.