phrenoesophageal

Phrenoesophageal refers to the anatomical relationship between the esophagus and the diaphragm, particularly at the esophageal hiatus. The phrenoesophageal membrane or ligament is a fibrous connection that anchors the distal esophagus to the diaphragmatic crura around the hiatus. This structure helps stabilize the gastroesophageal junction and maintain its alignment during breathing and swallowing.

Anatomy and relationships: The esophagus enters the abdomen through the diaphragmatic hiatus, roughly at the T10 level. The phrenoesophageal ligament forms a connective tissue link between the lower esophagus and the diaphragmatic crura, contributing to the integrity of the gastroesophageal junction. The arrangement supports the anti-reflux mechanism by maintaining a consistent spatial relationship between the stomach and the esophagus as the diaphragm moves with respiration.

Function: The phrenoesophageal apparatus works with the diaphragmatic crura and the lower esophageal sphincter to help keep the junction in the abdominal cavity. By limiting excessive herniation of esophagus or stomach into the thorax and aiding the closure of the hiatus during inspiration, it contributes to the overall competence of the gastroesophageal barrier.

Clinical significance: Disruption, laxity, or surgical modification of the phrenoesophageal connections can be involved in hiatal hernias. In sliding hiatal hernia, the gastroesophageal junction and part of the stomach migrate through the hiatus, while paraesophageal hernias involve herniation alongside the esophagus. Understanding phrenoesophageal anatomy is important in the diagnosis and surgical treatment of reflux and paraesophageal or sliding hernias.