Pattern of Venous Collateral Development After Splenic Vein Occlusion in an Extended Whipple Procedure
- 553 Downloads
The risks of developing sinistral portal hypertension as a result of occlusion of the splenic vein close to its termination during a Whipple procedure are unclear. Our purpose was to compare the pattern of venous collateral development after splenic vein ligation in an extended Whipple procedure with the pattern of collateral development in cases of sinistral portal hypertension.
Five patients underwent an extended Whipple procedure in which the splenic vein was divided and not reconstructed. Six to eight months later detailed mapping of venous return from the spleen was determined by contrast-enhanced multidetector computed tomography or in one case by 3D contrast-enhanced MRI. Spleen size and length of residual patent splenic vein were also measured. The literature on sinistral portal hypertension was evaluated to ascertain whether the venous collateral pattern in cases of left-sided portal hypertension was similar to the pattern that developed when the splenic vein was ligated at its termination in the Whipple procedure.
A length of splenic vein remained patent in all five patients, measuring 4.5 to 11.5 cm from the spleen. Splenomegaly did not develop. Blood returned from the spleen by multiple collaterals including collaterals in the omentum and mesocolon. These types of collaterals do not develop in sinistral portal hypertension, nor is residual patent splenic vein seen.
Ligation of the splenic vein close to its termination in five patients resulted in a pattern of venous return different from patients that have developed left-sided portal hypertension.
KeywordsWhipple procedure Mesenteric vein resection Superior mesenteric vein Portal vein Splenic vein Sinestral portal hypertension Left sided portal hypertension
- 2.Fuhrman GM, Leach SD, Staley CA, et al. Rationale for en bloc vein resection in the treatment of pancreatic adenocarcinoma adherent to the superior mesenteric-portal vein confluence. Pancreatic Tumor Study Group. Ann Surg 1996;223:154–62.Google Scholar
- 3.Tamura K, Sumi S, Koike M, Yano S, Nagami H, Nio Y. A splenic-inferior mesenteric venous anastomosis prevents gastric congestion following pylorus preserving pancreatoduodenectomy with extensive portal vein resection for cancer of the head of the pancreas. Internat Surg 1997;82:155–9.Google Scholar
- 8.Yoshimi F, Asato Y, Tanaka R, et al. Reconstruction of the portal vein and the splenic vein in pancreaticoduodenectomy for pancreatic cancer. Hepato-Gastroent 2003;50:856–60.Google Scholar
- 23.Armitage JO. Spleen. In: Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Walker HK, Hall WD, Hurst JW, Editors. Boston: Butterworths; 1990. Chapter 150Google Scholar
- 32.Chellappa M, Yee CK, Gill DS. Left-sided portal hypertension from malignant islet cell tumour of the pancrease: review with a case report. Journal of the Roy Coll Surg Edin 1986;31:251–2.Google Scholar
- 33.Singh K, Zargar SA, Bhasin D, Malik AK, Nagi B, Bose SM. Isolated splenic vein thrombosis with natural shunt caused by jejunal tuberculosis. Tropical Gastroenterol 1990;11:39–43.Google Scholar
- 36.Seenu V, Goel AK, Shukla NK, Dawar R, Sood S. Hodgkin’s lymphoma of colon: an unusual cause of isolated splenic vein obstruction. Ind J Gastroenterol 1994;13:70–1.Google Scholar