Medical Terminology Daily (MTD) is a blog sponsored by Clinical Anatomy Associates, Inc. as a service to the medical community. We post anatomical, medical or surgical terms, their meaning and usage, as well as biographical notes on anatomists, surgeons, and researchers through the ages. Be warned that some of the images used depict human anatomical specimens.

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A Moment in History

Jean-Louis Petit

Jean Louis Petit
(1674 – 1750)

French surgeon and anatomist, Jean Louis Petit was born in Paris in on March 13, 1674.  His family rented an apartment at his house to Alexis Littre (1658 – 1726), a French anatomist. Petit became an apprentice of Littre at seven years of age, helping him in the dissections for his lectures and at an early age became the assistant in charge of the anatomic amphitheater.

Because of Petit’s dedication to anatomy and medicine, in 1690 at the age of sixteen, became a disciple of a famous Paris surgeon, Castel.

In 1692, Petit entered the French army and performed surgery in two military campaigns. By 1693 he started delivering lectures and was accepted as a great surgeon, being invited to the most difficult operations.  In 1700 he was appointed Chief Surgeon of the Military School in Paris and in the same year he received the degree of Master of Surgery from the Faculty of Paris.

In 1715 he was made a member of the Royal Academy of Sciences and an honorary member of the Royal Society of London. He was appointed by the King as the first Director General of the Royal Academy of Surgery when it was founded in 1731.

Petit’s written works are of historical importance.  “Traite des Maladies des Os” ( A Treatise on Bone Diseases);  “Traite des Maladies Chirurgicales et des Operation” (A Treatise on Surgical Diseases and their Operations” This last book was published posthumously in 1774. He also published a monograph on hemorrhage, another on lachrymal fistula, and others.

He was one of the first to perform choIecystotomy and mastoidotomy. His original tourniquet design for amputations saved many in the battlefield and the design of the same surgical instrument today has not changed much since its invention by him.

His name is remembered in the lumbar triangle, also called the "triangle of Petit", and the abdominal hernia that can ensue through that area of weakness, the lumbar hernia or "Petit's hernia".

Sources:
1. “Jean Louis Petit – A Sketch of his Life, Character, and Writings” Hayne, AP San Fran Western Lancet 1875 4: 446-454
2. “Oeuvres compl?tes de Jean-Louis Petit” 1837 Imprimerie de F. Chapoulaud
3. Extraits de l'eloge de Jean-Louis Petit Ius dans Ia seance publique de I' Academie royale de chirurgie du 26 mai 1750” Louis A. Chirurgie 2001: 126 : 475- 81


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Incisura angularis

Anterior view of the stomach
Anterior view of the stomach


The term "incisura" is Latin, derived from the verb [incidere]* meaning "to cut" or [incisura]” meaning a "notch" or indentation in a structure, suggesting a distinctive incision, or cut. The second component, "angularis," is also Latin, derived from "angulus," which translates to "angle." The term "incisura angularis" can be translated as the "angular notch", a term that is also use for this gastric anatomical landmark.

The incisura angularis is a notch located along the lesser curvature of the stomach. Externally, it marks the transition between the body (corpus) and antrum of the stomach, an abdominal viscus. It is related to the gastrohepatic portion of the lesser omentum superolaterally. It should be mentioned that the lesser curvature vascular arcade runs within the lesser omentum, closely related to the gastric lesser curvature.

Found approximately midway between the esophagogastric junction and the pylorus, this external anatomical feature is easily identifiable internally during gastric endoscopy.

Structurally, the incisura angularis is formed by a fold of mucous membrane on the inner surface of the stomach, creating a small recess along the lesser curvature.

The stomach, although it has the same layers as the rest of the GI tract, presents an extra muscular layer in the area of the lesser curvature, which renders this area less distensible forming a muscular channel called the magenstrasse.

The mucosa layer is the deepest of the stomach layer. Within it, three areas of gastric mucosa are usually described: pyloric, transitional, and fundic. The incisura angularis corresponds mostly to the transitional zone. When there are mucosal changes that shown an invasion of another type of mucosa, it can mean preneoplastic changes. For this reason, the incisura angularis is an area that, when biopsied, can show early cancerous changes, as well as muscular atrophy, intestinal metaplasia, and dysplasia.

Preservation of the anatomy of the incisura angularis is critical during a sleeve gastrectomy, the most common bariatric procedure worldwide. The objective of a sleeve gastrectomy is to reduce the size of the stomach by placing a curved staple line along the left border of the magenstrasse, a lesser known gastric anatomy term.

Because of the location of the incisura angularis, improper placement of a straight gastric stapler could cause stenosis or stricture at this level. Another potential postoperative problem in this procedure is gastroesophageal reflux disease (GERD) where some authors have proposed an omentopexy as a way to modify the angle of the incisura angularis.

Sources:
1. "The Origin of Medical Terms" Skinner, HA 1970 Hafner Publishing Co.
2. "Medical Meanings - A Glossary of Word Origins" Haubrich, WD. ACP Philadelphia
3 "Tratado de Anatomia Humana" Testut et Latarjet 8 Ed. 1931 Salvat Editores, Spain
4. “The Rarely Sampled Incisura Angularis Is Useful for the Detection of Gastric Preneoplastic Lesions” Singhal, A. , Saboorian, H. , Turner, K. , Rugge, M. & Genta, R. (2023). The American Journal of Gastroenterology, 118 (10S), S1407-S1407.
5. “Incisura angularis belongs to fundic or transitional gland regions in Helicobacter pylori-naive normal stomach: Sub-analysis of the prospective multi-center study” Nakajima, S at al Digestive Endoscopy 2021; 33: 125–132
6. “Increasing the angle at the incisura angularis using omentopexy reduces/prevents GERD symptoms five years after laparoscopic sleeve gastrectomy?” Presidential Grand Rounds. Surgery for Obesity and Related Diseases, Volume 18, Issue 8, Supplement, 2022
7. “Gastric POEM to treat incisura angularis torsion after sleeve gastrectomy” Baptista, A; Davila, M; Guzman, M. Endoscopy 2019; 51(04)
8. “Obstruction after Sleeve Gastrectomy, Prevalence, and Interventions: a Cohort Study of 9,726 Patients with Data from the SOReg” Sillen, L; Andersson, E, Edholm, D. OBES SURG 31, 4701–4707 (2021)

Note: Google Translate includes the symbol (?). Clicking on it will allow you to hear the pronunciation of the word.