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The transpyloric plane, also known as Addison's plane, is an imaginary
horizontal plane In astronomy, geography, and related sciences and contexts, a '' direction'' or '' plane'' passing by a given point is said to be vertical if it contains the local gravity direction at that point. Conversely, a direction or plane is said to be h ...
, located halfway between the suprasternal notch of the manubrium and the upper border of the symphysis pubis at the level of the first lumbar vertebrae, L1. It lies roughly a hand's breadth beneath the
xiphisternum The xiphoid process , or xiphisternum or metasternum, is a small cartilaginous process (extension) of the inferior (lower) part of the sternum, which is usually ossified in the adult human. It may also be referred to as the ensiform process. Bot ...
or midway between the xiphisternum and the umbilicus. The plane in most cases cuts through the pylorus of the stomach, the tips of the ninth costal cartilages and the lower border of the
first lumbar vertebra The lumbar vertebrae are, in human anatomy, the five vertebrae between the rib cage and the pelvis. They are the largest segments of the vertebral column and are characterized by the absence of the foramen transversarium within the transverse ...
.


Structures crossed

The transpyloric plane is clinically notable because it passes through several important abdominal structures. It also divides the supracolic and
infracolic compartment The peritoneal cavity is a potential space between the parietal peritoneum (the peritoneum that surrounds the abdominal wall) and visceral peritoneum (the peritoneum that surrounds the internal organs). The parietal and visceral peritonea are lay ...
s, with the liver, spleen and gastric fundus above it and the small intestine and colon below it.


Lumbar vertebra and spinal cord

The first
lumbar vertebra The lumbar vertebrae are, in human anatomy, the five vertebrae between the rib cage and the pelvis. They are the largest segments of the vertebral column and are characterized by the absence of the foramen transversarium within the transverse ...
lies at the level of the transpyloric plane. Despite the
conus medullaris ''Conus'' is a genus of predatory sea snails, or cone snails, marine gastropod mollusks in the family Conidae.Bouchet, P.; Gofas, S. (2015). Conus Linnaeus, 1758. In: MolluscaBase (2015). Accessed through: World Register of Marine Species at ...
, the end of the spinal cord, being understood to terminate at the level of the transpyloric plane, there is significant variability. Up to 40% of people have spinal cords ending below the transpyloric plane.


Stomach

The transpyloric plane passes through the pylorus of the stomach, despite it being suspended by the
lesser Lesser, from Eliezer (, "Help/Court of my God"), is a surname. Notable people with the surname include: * Adolf Lesser (1851–1926), German physician * Aleksander Lesser (1814–1884), Polish painter and art critic * Anton Lesser (born 1952), Br ...
and
greater omentum The greater omentum (also the great omentum, omentum majus, gastrocolic omentum, epiploon, or, especially in animals, caul) is a large apron-like fold of visceral peritoneum that hangs down from the stomach. It extends from the greater curvature ...
and being relatively mobile.Drake, Richard L.; Wayne, Vogl A.; Mitchell, Adam W.M. (2015).
Gray's Anatomy for Students
' (3rd ed.) Philadelphia: Churchill Livingstone Elsevier. p. 311.


Duodenum

The horizontal part of the
duodenum The duodenum is the first section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear, and the terms anterior intestine or proximal intestine m ...
slopes upwards to the left of the vertical midline, following which the vertical ascending part of the duodenum reaches the transpyloric plane. It ends in the duodenojejunal junction, which lies approximately 2.5 cm to the left of the midline and just below the transpyloric plane.


Pancreas

The neck of pancreas lies on the transpyloric plane, whilst the body and tail are to the left and above it.


Gallbladder

The fundus of the gallbladder projects from the liver’s inferior border at the intersection of the transpyloric plane and the right lateral midline.


Kidneys

Despite the right kidney lying 1 cm lower than the left (right just below and the left just above the plane), to be practical, the surface markings are taken the same way. The hilum of the kidney on the left and right is taken as 5 cm from the vertical midline and is on the transpyloric plane.


Vasculature

The superior mesenteric artery arises from the
aorta The aorta ( ) is the main and largest artery in the human body, originating from the left ventricle of the heart and extending down to the abdomen, where it splits into two smaller arteries (the common iliac arteries). The aorta distributes o ...
at the level of the transpyloric plane and emerges between the head and neck of the pancreas. The superior mesenteric vein is joined by the splenic vein to form the
portal vein The portal vein or hepatic portal vein (HPV) is a blood vessel that carries blood from the gastrointestinal tract, gallbladder, pancreas and spleen to the liver. This blood contains nutrients and toxins extracted from digested contents. Approx ...
at the level of the transpyloric plane.


Spleen

The lower border of the spleen lies near the transpyloric plane.


Other structures

* the left and right colic flexure * the root of the transverse mesocolon. * cisterna chyli (which drains into the
thoracic duct In human anatomy, the thoracic duct is the larger of the two lymph ducts of the lymphatic system. It is also known as the ''left lymphatic duct'', ''alimentary duct'', ''chyliferous duct'', and ''Van Hoorne's canal''. The other duct is the rig ...
).


History

The transpyloric plane relates to the three-dimensional mapping of the abdomen founded on more than 10,000 measurements completed on 40 bodies, that surgeon Viscount Addison took at the turn of the 20th century.Addison, Sir Christopher, Viscount Addison of Stallingborough (1869 - 1951).
Royal College of Surgeons: Plarr's Lives of the Fellows Online. Retrieved 16 March 2018.
Addison reported his findings in a paper titled, "On the anatomical topography of the abdominal viscera in man, especially the gastro-intestinal canal" in which he established a baseline for the anatomy of the abdomen based on the arrangement of the map of the Earth. Using the suprasternal notch as the North Pole of the trunk, and the upper border of the pubic symphysis as the South Pole, he drew a vertical line joining these two points as his meridian. At the meridian's midpoint, he then drew a perpendicular line corresponding to the
Equator The equator is a circle of latitude, about in circumference, that divides Earth into the Northern and Southern hemispheres. It is an imaginary line located at 0 degrees latitude, halfway between the North and South poles. The term can also ...
. As this transverse plane crossed the pylorus, he called it the transpyloric plane.


Images

File:Surface projections of the organs of the trunk.png, Surface projections of the organs of the
trunk Trunk may refer to: Biology * Trunk (anatomy), synonym for torso * Trunk (botany), a tree's central superstructure * Trunk of corpus callosum, in neuroanatomy * Elephant trunk, the proboscis of an elephant Computing * Trunk (software), in rev ...
, with transpyloric plane labeled at L1 File:Gray1034.png, Front view of the thoracic and abdominal viscera.
a. Median plane.
b. Lateral planes.
c. Trans tubercular plane.
d. Subcostal plane.
e. Transpyloric plane. File:Gray1227.png, Front of abdomen, showing surface markings for arteries and inguinal canal.


See also

* Transtubercular plane


References


External links


Planes of the trunk
{{Authority control Anatomy