Original Article

Journal of Gastrointestinal Surgery

, Volume 18, Issue 5, pp 917-921

Optimal Management of the Splenic Vein at the Time of Venous Resection for Pancreatic Cancer: Importance of the Inferior Mesenteric Vein

  • Charles H. C. PilgrimAffiliated withPancreatic Cancer Program, Department of Surgery, Division of Surgical Oncology, The Medical College of Wisconsin
  • , Susan TsaiAffiliated withPancreatic Cancer Program, Department of Surgery, Division of Surgical Oncology, The Medical College of Wisconsin
  • , Parag TolatAffiliated withDepartment of Radiology, The Medical College of Wisconsin
  • , Parag PatelAffiliated withDepartment of Radiology, The Medical College of Wisconsin
  • , William RillingAffiliated withDepartment of Radiology, The Medical College of Wisconsin
  • , Douglas B. EvansAffiliated withPancreatic Cancer Program, Department of Surgery, Division of Surgical Oncology, The Medical College of Wisconsin
  • , Kathleen K. ChristiansAffiliated withPancreatic Cancer Program, Department of Surgery, Division of Surgical Oncology, The Medical College of Wisconsin Email author 

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Abstract

Background

Resection of the superior mesenteric vein (SMV)-portal vein (PV)-splenic vein (SV) confluence during pancreatectomy for pancreatic cancer requires management of the SV.

Discussion

Simple SV ligation can result in sinistral portal hypertension if the inferior mesenteric vein (IMV) enters the confluence and is thereby resected, or if the IMV is insufficient to drain the SV. We describe herein three patients whose clinical course confirms the importance of the IMV decompressing the SV to avoid sinistral hypertension.

Keywords

Pancreas cancer Splenic vein Sinistral hypertension Inferior mesenteric vein Venous resection