scholarly journals A Thought-Provoking Case of Successfully Treated Carcinoma of the Head of the Pancreas with Metachronous Lung Metastasis: Impact of Distal Spleno-Renal Shunt for Regional Invasion on Long-Term Period after Pancreaticoduodenectomy

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Ryuhei Aoyama ◽  
Tomohide Hori ◽  
Hidekazu Yamamoto ◽  
Hideki Harada ◽  
Michihiro Yamamoto ◽  
...  
Keyword(s):  
Portal Vein ◽  
Lung Metastasis ◽  
Superior Mesenteric Vein ◽  
Tumor Resection ◽  
Splenic Vein ◽  
Splenorenal Shunt ◽  
Distal Splenorenal Shunt ◽  
Mesenteric Vein ◽  
Initial Surgery ◽  
Head Of The Pancreas

When performing pancreaticoduodenectomy with resection of the confluence of the superior mesenteric vein and portal vein, division of the splenic vein may cause sinistral portal hypertension resulting in gastrointestinal bleeding, splenic congestion, and hypersplenism. To prevent these adverse events, it is important to intentionally decompress the splenic vein. This report is of a 68-year-old woman with stage IA carcinoma of the head of the pancreas who survived for more than six years following tumor resection and pancreaticoduodenectomy and distal splenorenal shunt. A 68-year-old woman was diagnosed with carcinoma of the head of the pancreas that involved the confluence of the superior mesenteric vein, portal vein, and splenic vein. No unresectable cancer sites or distant metastases were detected. Pancreaticoduodenectomy with resection of the confluence of the superior mesenteric vein and portal vein was performed. The superior mesenteric vein and portal vein were anastomosed in the end-to-end fashion, and the remnant splenic vein was anastomosed to the superior aspect of the left renal vein in the end-to-side fashion. At 22 months after the initial surgery, the patient underwent partial lung resection for a metachronous lung metastasis. For 6 years after the initial surgery, the venous reconstructions have maintained their patency without any obstruction of splenic venous flow, and the patient has remained in good health without further metastases or recurrences. This case has shown the importance of early diagnosis of carcinoma of the head of the pancreas, as appropriate and timely surgical management can result in good outcome. This patient responded well and remains alive six years following pancreaticoduodenectomy and preservation of the spleen with the use of a distal splenorenal shunt.

scholarly journals Splenic vein reconstruction is unnecessary in pancreatoduodenectomy combined with resection of the superior mesenteric vein–portal vein confluence according to short-term outcomes

HPB ◽  
2017 ◽  
Vol 19 (9) ◽  
pp. 785-792 ◽  
Author(s):  
Haruyoshi Tanaka ◽  
Akimasa Nakao ◽  
Kenji Oshima ◽  
Kiyotsugu Iede ◽  
Yukiko Oshima ◽  
...  
Keyword(s):  
Portal Vein ◽  
Superior Mesenteric Vein ◽  
Splenic Vein ◽  
Short Term ◽  
Mesenteric Vein

Contribution of Superior Mesenteric Vein Flow to the Right and Left Lobes of the Liver Using CFD

2009 ◽  
Author(s):  
Stephanie M. George ◽  
Diego R. Martin ◽  
Don P. Giddens
Keyword(s):  
Portal Vein ◽  
Superior Mesenteric Vein ◽  
Splenic Vein ◽  
Normal Subjects ◽  
Diagnostic Techniques ◽  
Mesenteric Vein ◽  
Right Lobe ◽  
Computational Fluid Dynamics Cfd ◽  
The Right ◽  
End Stage

The incidence of cirrhosis, the end stage for many liver diseases, is rising and with it the need for better understanding of the progression of the disease and diagnostic techniques. The authors have noted that liver disease occurs preferentially in the right side of the liver which is the largest lobe. One hypothesis is that this is due to the composition of the blood that supplies the right lobe. The liver is fed by both the hepatic artery and the portal vein with the portal vein contributing about 80% of the blood supply. The portal vein (PV) is supplied by the superior mesenteric vein (SMV), which drains blood from the digestive track, and the splenic vein (SV), which drains blood from the spleen. Since the blood in the SMV is coming from the digestive track, it carries toxins and items absorbed during digestion. Toxins such as alcohol are known to damage the liver. Thus, our hypothesis is that the majority of the SMV flow feeds into the right portal vein and ultimately the right lobe of the liver. This study seeks to assess the validity of our hypothesis in four subjects by creating subject specific models in two normal subjects and two patients and using computational fluid dynamics (CFD) to calculate the SMV contribution to the right portal vein.

scholarly journals Pancreaticoduodenectomy for ductal adenocarcinoma of the pancreatic head with venous resection

2016 ◽  
Vol 50 (3) ◽  
pp. 321-328 ◽  
Author(s):  
Vojko Flis ◽  
Stojan Potrc ◽  
Nina Kobilica ◽  
Arpad Ivanecz
Keyword(s):  
Portal Vein ◽  
Superior Mesenteric Vein ◽  
Splenic Vein ◽  
Vascular Resection ◽  
Synthetic Graft ◽  
En Bloc ◽  
Venous Reconstruction ◽  
Interposition Graft ◽  
Mesenteric Vein ◽  
Vein Resection

Abstract Background Recent reports have shown that patients with vascular tumour invasion who undergo concurrent vascular resection can achieve long-term survival rates equivalent to those without vascular involvement requiring pancreaticoduodenectomy alone. There is no consensus about which patients benefit from the portal-superior mesenteric vein resection and there is no consensus about the best surgical technique of vessel reconstruction (resection with or without graft reconstruction). As published series are small the aim of this study was to evaluate our experience in pancreatectomies with en bloc vascular resection and reconstruction of vessels. Methods Review of database at University Clinical Centre Maribor identified 133 patients (average age 65.4 ± 8.6 years, 69 female patients) who underwent pancreatoduodenectomy between January 2006 and August 2014. Clinical data, operative results, pathological findings and postoperative outcomes were collected prospectively and analyzed. Current literature and our experience in pancreatectomies with en bloc vascular resection and reconstruction of portal vein are reviewed. Results Twenty-two patients out of 133 (16.5%) had portal vein-superior mesenteric vein resection and portal vein reconstruction (PVR) during pancreaticoduodenectomy. In fourteen patients portal vein was reconstructed without the use of synthetic vascular graft. In these series two types of venous reconstruction were performed. When tumour involvement was limited to the superior mesenteric vein (SPV) or portal vein (PV) such that the splenic vein could be preserved, and vessels could be approximated without tension a primary end-to-end anastomosis was performed. When tumour involved the SMV-splenic vein confluence, splenic vein ligation was necessary. In the remaining eight procedures interposition graft was needed. Dacron grafts with 10 mm diameter were used. There was no infection after dacron grafting. One patient had portal vein thrombosis after surgery: it was thrombosis after primary reconstruction. There were no thromboses in patients with synthetic graft interposition. There were no significant differences in postoperative morbidity, mortality or grades of complication between groups of patients with or without a PVR. Median survival time in months was in a group with vein resection 16.13 months and in a group without vein resection 15.17 months. Five year survival in the group without vein resection was 19.5%. Comparison of survival curves showed equal hazard rates with log-rank p = 0.090. Conclusions Survival of patients with pancreatic cancer who undergo an R0 resection with reconstruction was comparable to those who have a standard pancreaticoduodenectomy with no added mortality or morbidity. Synthetic graft appeared to be an effective and safe option as an interposition graft for portomesenteric venous reconstruction after pancreaticoduodenectomy.

scholarly journals ANATOMICAL VARIANTS OF INFERIOR MESENTERIC VEIN ACCORDING ON THE DATA OF MULTISPIRAL COMPUTED TOMOGRAPHY

2021 ◽  
Vol 28 (4) ◽  
pp. 31-37
Author(s):  
Aleksandr V. Kolsanov ◽  
Maksim N. Myakotnykh ◽  
Aleksey A. Mironov ◽  
Renat R. Yunusov
Keyword(s):  
Computed Tomography ◽  
Portal Vein ◽  
Superior Mesenteric Vein ◽  
Splenic Vein ◽  
Common Trunk ◽  
Inferior Mesenteric Vein ◽  
Mesenteric Vein ◽  
Vein Formation ◽  
Vascular Bed ◽  
The Common

Knowledge of the variants of the anatomical variability of the liver vascular bed can be of critical importance in liver resection, liver transplantation, laparoscopic operations, resection of the pancreas, surgical treatment of portal hypertension The main vessels of the hepatic portal vein system are characterized by pronounced anatomical variability in the formation of the portal vein trunk, the greatest variability is characterized by inferior mesenteric vein. The aim of the investigation was to study the variant anatomy of the inferior mesenteric vein according to multispiral computed tomography. The material was 100 multispiral computed tomograms of the abdominal organs from the archive of the clinics of the Samara State Medical University for 2018-2019. For mathematical modeling and the creation of three-dimensional models based on tomograms of the vascular bed, plugins were used in the programs «Luch» and «Autoplan». Variants of the portal vein formation, the angle of inflow of the inferior mesenteric vein into the superior mesenteric and splenic veins, the distance from the point of confluence of the inferior mesenteric vein to the point of confluence with the portal vein were studied. The study revealed that the inferior mesenteric vein in 40% of cases flows into the splenic vein, in 39% - into the angle of confluence of the superior mesenteric and splenic veins, in 16% - into the superior mesenteric vein. In 5% of cases, the absence of the inferior mesenteric vein was revealed. The angle of fusion of the inferior mesenteric vein with the superior mesenteric vein was statistically significantly greater than the angle of fusion of the inferior mesenteric vein with the splenic vein. The angles were 76.36 ± 1.53 ° and 64.89 ± 3.52 °, respectively (p = 0.004). The length of the common trunk of the inferior mesenteric and splenic veins was significantly greater than the common trunk of the mesenteric veins and amounted to 16.98 ± 1.09 mm and 9.37 ± 0.65 mm (p = 0.001), respectively. Thus, the study showed a high degree of anatomical variability of the inferior mesenteric vein.

scholarly journals Anatomic study of portal vein: transpancreatic vessels injuries approach

2002 ◽  
Vol 17 (4) ◽  
pp. 225-231 ◽  
Author(s):  
Mario Mantovani ◽  
Raquel Franco Leal ◽  
Mauro José Fontelles
Keyword(s):  
Portal Vein ◽  
Superior Mesenteric Vein ◽  
Transverse Section ◽  
Splenic Vein ◽  
High Rate ◽  
Initial Portion ◽  
Mesenteric Vein ◽  
Surgical Access ◽  
Upper Limit ◽  
Inferior Border

Introduction: The commitment of the great blood-vessels make up a situation of great complexity and a high rate of the complications and mortality patients with abdominal trauma. The injury of the portal vein matters because of the difficulty on the diagnosis and the approach surgery. Objective: To set the standard on the transverse section of the pancreas looking for a safer surgical access to repair the portal vein injuries. Methods: A quantitative analysis was performed to characterize the anatomical relationship between the portal vein and their tributaries relating them to the pancreas. On these corpses, the measurements of a anatomical triangle were studied. It base was the upper limit of the superior mesenteric vein and the initial portion of the portal vein; the apex, a point located on the upper limit of the confluence of the splenic vein and superior mesenteric vein, situated at the middle line of the superior mesenteric_ vein. Results: The portal vein is formed 3.24cm from the internal border of the duodenal arc at a distance of 1.61cm and 1.07 from the inferior and superior pancreas borders, respectively. Conclusion: The present study allow us to conclude that, to have access to the origin of the portal vein, in case of trauma of this vessel, one should proceed a transverse section of the neck of the pancreas next to the superior mesenteric vein, because its confluence with splenic vein occur, on average, 1.07cm and 1.61cm from the superior and inferior border of the gland, respectively.

scholarly journals Anomalous formation of the portal vein: a case report

2007 ◽  
Vol 6 (4) ◽  
pp. 399-401 ◽  
Author(s):  
Vasavi Rakesh Gorantla ◽  
Bhagath Kumar Potu ◽  
Thejodhar Pulakunta ◽  
Venkata Ramana Vollala ◽  
Pavan Kumar Addala ◽  
...  
Keyword(s):  
Case Report ◽  
Portal Vein ◽  
Surgical Procedures ◽  
Superior Mesenteric Vein ◽  
Splenic Vein ◽  
Traumatic Rupture ◽  
Left Gastric Vein ◽  
Mesenteric Vein ◽  
Anomalous Formation ◽  
Abnormal Termination

The knowledge about the formation and relations of the portal vein is important for surgeons and radiologists. The variations in the level of formation and the pattern of formation of portal vein might lead to confusions during radiological and surgical procedures. Here we present a rare variation in the formation of the portal vein as found during the cadaveric dissections. The portal vein was formed by the union of splenic vein, superior mesenteric vein and inferior mesenteric veins. The abnormal termination of left gastric vein into superior mesenteric vein before the formation of portal vein was also seen in the same cadaver. Identification of these variations is useful in managing traumatic rupture of the mesentery.

Ultrasonographic Investigation of Respiratory Influence on Diameters of Portal Vessels in Normal Subjects

1986 ◽  
Vol 27 (6) ◽  
pp. 675-680 ◽  
Author(s):  
M. Kurol ◽  
L. Forsberg
Keyword(s):  
Portal Hypertension ◽  
Food Intake ◽  
Portal Vein ◽  
Healthy Subjects ◽  
Superior Mesenteric Vein ◽  
Splenic Vein ◽  
Normal Subjects ◽  
Respiratory Variation ◽  
Mesenteric Vein

In order to improve the basis for ultrasonographic studies of portal hypertension the normal diameters and respiratory variations in the portal vessels were measured in sixty-seven volunteers. In healthy subjects, measurements were made on the portal vein and its major tributaries. The respiratory variations were most prominent in the splenic vein, somewhat less in the superior mesenteric vein and least in the portal vein. There were no significant correlations to weight, age or height. The hypothesis that examinations performed after food intake would give more prominent respiratory variations had to be rejected but showed that the portal vein should be examined under defined conditions regarding alimentary status. The diameters alone of the portal vessels can probably not be used reliably as an indicator of portal hypertension while a respiratory variation of less than 30 per cent in the splenic vein should be considered pathologic and lead to further investigations.

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