Protected by the lower ribs, the upper abdominal viscera take a horseshoe configuration draped over the lumbar spine, placing the pancreas and great vessels within centimeters of the anterior abdominal wall. Epigastric blunt trauma can crush the body of the pancreas against the spine.
The posterior musculoskeletal parieties shape the bed that the viscera conform to. The spleen lies far posterior and cephalad beneath the diaphragm. The transverse colon drapes downward over the small intestine when the individual is upright. The body of the stomach, paralleling the curve of the transverse colon, can descend below the level of the umbilicus.
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The esophagus descends in the posterior mediasinum in a spiral relationship to the aorta. When one performs open exploration of the abdomen, the esophagus is located by palpating the pulsation of the underlying aorta. Esophageal perforation causes mediastinitis, first manifested by tachycardia. Upper esophageal cancers can erode into the trachea resulting in tracheo-esophageal fistula.