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Midgut

Territory · D2 papilla → 2/3 transverse Periumbilical pain

Supplied by the SMA: duodenum distal to the major papilla, jejunum, ileum, caecum, appendix, ascending colon and proximal two-thirds of the transverse colon. Visceral afferents run with the lesser splanchnic nerves to T10–T11, so pain is felt around the umbilicus.

Traced from the start

  1. Abdominal aorta
  2. Superior mesenteric artery
  3. Ileocolic arteryMiddle colic arteryJejunal and ileal arteries
  4. Midgut

Detail

Extent
Major duodenal papilla to the proximal two-thirds of the transverse colon
Arterial supply
Superior mesenteric artery (L1)
Referred pain
Periumbilical (T10–T11, lesser splanchnic nerve)

When it goes wrong

Early appendicitis

Periumbilical visceral pain (T10) that shifts to the right iliac fossa once the parietal peritoneum is inflamed

Midgut volvulus in malrotation (a narrow mesenteric base twisting around the SMA)

Bilious vomiting in a neonate with the entire SMA territory at risk of infarction

Practise this structure

2 questions in the bank tagged Referred Pain.

A 22-year-old man is struck in the left lower chest by a cricket ball. Two hours later he has constant pain at the tip of the left shoulder, worse when he lies…

Foundations · common

A 62-year-old man has had 4 months of worsening constipation with cramping pain that comes in waves and eases after a few minutes; he cannot point to one spot w…

Foundations · middle twist