Our Sponsors caatmsmtdad    Medical Terminology Daily (MTD) is a blog prepared by Clinical Anatomy Associates, Inc. as a service to the medical community, medical students, and the medical industry. We will post a workweek daily medical or surgical term, its meaning and usage, as well as biographical notes on anatomists, surgeons, and researchers through the ages. Be warned that some of the images used depict human anatomical specimens.

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 Moment in History

Dr. John Benjamin Murphy

Dr. John Benjamin Murphy
(1857 – 1916)

An American surgeon, John Benjamin Murphy was born in Appleton, Wisconsin in 1857. He studied anatomy and physiology in Appleton under the care of Dr. H.W. Reilly, a local physician, after which J.B. Murphy entered the Rush Medical College, receiving his degree in 1879.  

Urged by the new trends in surgery and antisepsis, in 1882 Dr. Murphy he traveled to Vienna to study with Theodor Billroth (1829 – 1894), and then on to Heidelberg and Berlin. Upon his return, he started great advances in the surgery of the time. One of them was to propose the immediate extirpation of the vermiform appendix when acute appendicitis was diagnosed, as opposed to the common practice of waiting until the vermiform appendix ruptured. 

In 1892 Dr. Murphy became professor of clinical surgery at the College of Physicians and Surgeons in Chicago. Dr. Murphy is one of the founders of the American College of Surgeons. His surgical endeavors span many specialties including abdominal, thoracic, peripheral vascular, orthopedics, neurosurgery, etc. 

One of his well-known inventions was a metal sutureless compression anastomotic device, known to many as the “Murphy button”. Although in 1826 Denans and Henroz had created metal compression anastomotic devices with a similar concept, Murphy’s improvements on the device caused it to be used well into the 1900’s. The reason for this is the support the device had from the Mayo brothers, founders of the today well-known Mayo Clinic. Although not a stapler, the Murphy button established the need for anastomotic leakage control and the possibility of and end-to-end anastomosis. This makes Dr. Murphy's concept part of the history of surgical stapling. For an image of the Murphy anastomotic device click here, the link is courtesy of the Museum of Health Care at Kingston, Canada.

Murphy’s first use for his device was for a cholecystojejunostomy, the anastomosis of the gallbladder to the jejunum to allow drainage of the bile into the digestive system. 

His name is remembered in many eponyms: Murphy’s button, Murphy’s drip, Murphy’s test, Murphy’s punch, and the Murphy-Lane bone skid.

Sources: 1. “Cholecystointestinal, gastrointestinal, enterintestinal anastomosis, and approximation without sutures” Murphy JB. Med Rec (1892) 42: 665
2 . “John Benjamin Murphy – Pioneer of gastrointestinal anastomosis” Bhattacharya, K., & Bhattacharya, N. (2008). Indian J. Surg., 70, 330-333.
3. “The Story of Surgery” Graham, H. (1939) New York: Doubleday, Doran & Co.. Inc.
4. “Compression Anastomosis: History and Clinical Considerations”Kaidar-Person, O, et al, e. (2008) Am J Surg, 818-826.
5. “Current Practice of Surgical Stapling” Ravitch, M. M., Steichen, F. M., & Welter, R. (1991) Philadelphia: Lea& Febiger.
“Rese¤as Históricas: John Benjamin Murphy” Parquet, R.A. Acta Gastroenterol Latinoam 2010;40:97

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Ligament of Treitz

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The ligament of Treitz is formed by a fold of peritoneum over the suspensory muscle of the duodenum. This muscle is also known as the "muscle of Treitz" or "musculus suspensorius duodenii". This muscle was first described in 1853 by Dr. Václav Treitz. 

The muscle (see image #1) has an unusual structure in that it is formed by a tendon with two muscular ends  of dissimilar embryological origin and function. The superior muscular component is skeletal (voluntary) muscle and arises as a slip of muscle (Hilfsmuskel) from the right esophageal crus of the respiratory diaphragm, as well as muscular and ligamentous fibers arising in the region of origin of the celiac trunk and superior mesenteric artery. The inferior portion of the muscle is smooth (involuntary) muscle and has been described as continuous with both the longitudinal and circular muscle layer of the intestine at the duodenojejunal junction.

Anterior view of the duodenum and the suspensory muscle of the duodenum
Click on the image for a larger version
Original image by Dr. Václav Treitz
The ligament of Treitz is an anatomical landmark used by anatomists and surgeons to denote the duodenojejunal junction and the point where the small intestine passes from retroperitoneal duodenum to intraperitoneal jeunum. Surgeons use the ligament of Treitz to measure the jejunum to decide where to perform an anastomosis.Click on the gray bar below the image to see the original sketch published by Dr. Václav Treitz in his 1853 publication "Ueber einen neuen Muskel am Duodenum des Menschens" (On a new muscle in the duodenum of man). The 'muscle of Treitz" is marked by an arrow.

It is important to clarify that the term "ligament" in the abdominopelvic cavity has a different meaning and structure from a skeletal ligament found in a joint. For more information click here.

Clinical anatomy, pathology, and surgery of the gastrointestinal tract are some of the many lecture topics developed and delivered to the medical devices industry by Clinical Anatomy Associates, Inc.

"Clinically Oriented Anatomy" Moore, KL. 3r Ed. Williams & Wilkins 1992
2. "The origin of Medical Terms" Skinner, AH, 1970
3. "The suspensory muscle of the duodenum and its nerve supply" Jit, I.; Singh, S. J. Anat. (1977), 123, 2, pp. 397-405
4. "Anatomical and functional aspects of the human suspensory muscle of the duodenum." Costacurta, L. Acta Anat (Basel). 1972;82(1):34-46
Image property of: CAA.Inc. Artists: Dr. E. Miranda and D.M. Klein