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Abdominal part of esophagus

The abdominal part of the esophagus is the short terminal segment of the esophagus, approximately 1–2 cm in length, located between the esophageal hiatus of the diaphragm and the cardial orifice of the stomach. It lies in the left upper abdomen, anterior to the left crus of the diaphragm, and continues into the stomach at the gastroesophageal junction.

This segment is enclosed by the phrenoesophageal ligament, which anchors it at the diaphragm. The abdominal esophagus is of great clinical importance as it contains the lower esophageal sphincter (LES) region, which regulates the passage of food into the stomach and prevents reflux. Weakness in this area leads to conditions such as gastroesophageal reflux disease (GERD) and hiatal hernia.

Synonyms

  • Distal esophagus

  • Abdominal esophageal segment

  • Gastroesophageal segment

Function

  • Serves as the terminal conduit for food and liquid into the stomach

  • Houses the lower esophageal sphincter (LES), preventing gastric reflux

  • Coordinates with diaphragmatic crura to maintain anti-reflux barrier

  • Plays a role in swallowing and gastric emptying mechanics

Nerve Supply

  • Parasympathetic: Esophageal plexus formed by the vagal trunks

  • Sympathetic: Greater splanchnic nerves via the celiac plexus

  • Provides autonomic innervation for peristalsis and sphincter control

Arterial Supply

  • Primarily from the left gastric artery (branch of celiac trunk)

  • Small contributions from the left inferior phrenic artery

Venous Drainage

  • Drains into the left gastric vein, which communicates with the portal vein

  • Forms part of the porto-systemic anastomosis with the azygos system, a site prone to esophageal varices in portal hypertension

MRI Appearance

T1-weighted images:

  • Esophageal wall appears as intermediate signal intensity with clear distinction from adjacent fat

  • Lumen may show variable signal depending on swallowed contents

T2-weighted images:

  • Wall appears intermediate to low signal, lumen shows bright hyperintense fluid if distended

  • Useful for detecting edema, inflammation, or masses

STIR:

  • Suppresses fat, making the esophageal wall and surrounding pathology stand out

  • Highlights edema, tumor infiltration, or peri-esophageal inflammation

T1 Fat-Saturated (Pre-contrast):

  • Wall shows intermediate signal, standing out against suppressed fat of mediastinum and upper abdomen

T1 Fat-Saturated Post-Contrast (Gadolinium):

  • Normal wall shows thin, uniform enhancement

  • Pathologies (esophagitis, tumors) show thickened, heterogeneous enhancement

  • Detects early neoplasia, inflammation, and perfusion defects

MRI Non-Contrast 3D Imaging:

  • Provides 3D reconstruction of the distal esophagus and gastroesophageal junction

  • Useful for pre-surgical mapping of tumors, hiatal hernias, and reflux disease

CT Appearance

CT Pre-Contrast:

  • Esophagus seen as a soft-tissue tubular structure just below the diaphragm

  • Distended lumen may contain air or fluid, useful in detecting obstruction

CT Post-Contrast:

  • Esophageal wall enhances moderately and uniformly

  • Thickening, irregularity, or heterogeneous enhancement suggests malignancy, esophagitis, or varices

  • Useful for staging of distal esophageal cancer and hiatal hernia assessment

CT images

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