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Cavernous Transformation of the Portal Vein Requiring Temporary Mesocaval Shunt and Internal Jugular Vein Interposition Graft

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Case-Based Lessons in the Management of Complex Hepato-Pancreato-Biliary Surgery

Abstract

The current treatment of pancreatic cancer involves a multidisciplinary team providing multimodal therapies, which include chemotherapy, radiation, and surgery. With improvements in tumor response to contemporary systemic agents, surgical resection is now being considered for tumors that were previously believed to be technically unresectable. This chapter illustrates a complex situation where the pancreatic tumor caused segmental occlusion of the superior mesenteric portal vein confluence, resulting in cavernous transformation of the portal vein in the setting of proximal arterial abutment. We describe diversion of mesenteric flow through mesocaval shunting prior to portal dissection, which then allowed for a safe pancreatectomy enhanced by improved visualization of the superior mesenteric artery.

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Author information

Authors and Affiliations

  1. Department of Surgery, Medical College of Wisconsin/Froedtert Hospital, 9200 W Wisconsin Ave, 53226, Milwaukee, WI, USA

    George Younan & Kathleen K. Christians

  2. Department of Surgery, Medical College of Wisconsin/Froedtert Hospital, 9200 W Wisconsin Ave, Suite 3510, 53226, Milwaukee, WI, USA

    Douglas B. Evans

Authors
  1. George Younan
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  2. Douglas B. Evans
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  3. Kathleen K. Christians
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Corresponding author

Correspondence to Kathleen K. Christians .

Editor information

Editors and Affiliations

  1. The Ohio State Wexner Medical Center , The Ohio State University School of Medicine , Columbus, Ohio, USA

    Timothy M. Pawlik

  2. Division of General Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA

    Sharon Weber

  3. Medical College of Wisconsin, Milwaukee, Wisconsin, USA

    T. Clark Gamblin

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Younan, G., Evans, D.B., Christians, K.K. (2017). Cavernous Transformation of the Portal Vein Requiring Temporary Mesocaval Shunt and Internal Jugular Vein Interposition Graft. In: Pawlik, T., Weber, S., Gamblin, T. (eds) Case-Based Lessons in the Management of Complex Hepato-Pancreato-Biliary Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-50868-9_29

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  • DOI: https://doi.org/10.1007/978-3-319-50868-9_29

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-50867-2

  • Online ISBN: 978-3-319-50868-9

  • eBook Packages: MedicineMedicine (R0)

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