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Pattern of Venous Collateral Development After Splenic Vein Occlusion in an Extended Whipple Procedure

Comparison with Collateral Vein Pattern in Cases of Sinistral Portal Hypertension
  • Steven M. StrasbergEmail author
  • Sanjeev Bhalla
  • Luis A. Sanchez
  • David C. Linehan
Original Article

Abstract

Introduction

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Whipple procedure Mesenteric vein resection Superior mesenteric vein Portal vein Splenic vein Sinestral portal hypertension Left sided portal hypertension 

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Copyright information

© The Society for Surgery of the Alimentary Tract 2011

Authors and Affiliations

  • Steven M. Strasberg
    • 1
    Email author
  • Sanjeev Bhalla
    • 3
  • Luis A. Sanchez
    • 2
  • David C. Linehan
    • 1
  1. 1.Section of HPB Surgery, Department of SurgeryWashington University in Saint LouisSaint LouisUSA
  2. 2.Section of Vascular Surgery, Department of SurgeryWashington University in Saint LouisSaint LouisUSA
  3. 3.Mallinckrodt Institute of RadiologyWashington University in Saint LouisSaint LouisUSA

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