Atlas of Human Anatomy in Cross Section: Appendix: Topography of the Thorax and Abdomen
Ronald A. Bergman, Ph.D., Adel K. Afifi, M.D., Jean J. Jew, M.D., and Paul
C. Reimann, B.S.
Peer Review Status: Externally Peer Reviewed
Superior Portion of Duodenum
The highest part of the duodenum varies from about the lower third of the tenth thoracic vertebra to the first lumbar disk. The average position is at a level between the twelfth thoracic disk and the upper third of the first lumbar vertebra, according to Eycleshymer and Schoemaker. Merkel, Cunningham, and Piersol place it at the level of the first lumbar vertebra, and Joessel places it at the same level but states that this is the position when empty. The present study places the highest level at the lower third of the tenth thoracic vertebra.
Transverse Part
Eycleshymer and Schoemaker reported that the lower margin of the transverse part of the duodenum varies in location from the middle of the third lumbar vertebra to the fourth lumbar disk. The average position is opposite the middle of the fourth lumbar vertebra. Corning and Merkel place the transverse part of the duodenum opposite the third lumbar vertebra. Piersol, based on 54 observations, places its lowest point at the fourth lumbar vertebra or the disk above or below; Cunningham places it at the third lumbar spine. Fawcett and Blachford made a large number of observations "on the level at which the lower border of the third part of the duodenum crosses the vertebral column." Three hundred thirty-seven bodies were examined; of these, 190 were males and 147 were females. The most common position was opposite the middle third of the third lumbar vertebra. In males, the average level was about 1 cm higher than in females. "In no case was the duodenum found in the male below the fourth lumbar vertebra; as many as seven were below that vertebra in the female." The variations, according to these authors, range from the second lumbar vertebra to the fifth lumbar disk.
Duodenojejunal Flexure
The Duodenojejunal flexure varies in position from the middle of the eleventh thoracic vertebra to the second lumbar disk. The average position is at the level of the lower third of the first lumbar vertebra, according to Eycleshymer and Schoemaker. Joessel places it at the level of the first lumbar vertebra; Merkel, opposite the first lumbar disk; and Corning, opposite the first lumbar disk or second lumbar vertebra. Cunningham places the flexure in the transpyloric plane, which is at the level of the first lumbar vertebra, and Piersol places the flexure opposite the upper part of the second lumbar vertebra.
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