Dangerous Course and Atypical Termination of the Splenic Vein in Relation to Pancreas. A Case Report
Abstract
Context Knowledge of variations of the vessels closely related to the pancreas adds greatly to the success of pancreatic surgery. Splenic vein is one of the vessels that are closely related to the pancreas. Its variations might not only change the haemodynamics in the vein but also cause unexpected bleeding during pancreatic surgery. Case report During our dissection classes, we noted the variations in the course and termination of the splenic vein. After emerging from the spleen, it coursed upward and to the right, embedded in a groove on the anterior surface of body of pancreas. After reaching the upper border, it turned downwards and entered the body of the pancreas. After having a downward course in the body of pancreas, it emerged out and united with the superior mesenteric vein at an angle of about 160 degrees to form the portal vein. Conclusion This peculiar course of the vein might predispose it for thrombosis in case of pancreatitis. It can also lead to iatrogenic injuries during pancreatic or splenic surgeries.
Image: Downward course of the splenic vein before joining the superior mesenteric vein.
Downloads
References
Shin EK, Moon W, Park SJ, Park MI, Kim KJ. Congenital absence of the splenic artery and splenic vein accompanied with a duodenal ulcer and deformity. World J Gastroenterol. 2009; 15: 1401–1403. [PMID: 19294774]
Chitra PS, Maheshwari K, Anandhi V. Prepancreatic formation of portal vein associated with prepancreatic superior mesenteric artery and splenic vein. International Journal of Anatomical Variations 2014. 7: 35–36.
Shah OJ, Robbani I. Anteriorly placed splenic vein: the first reported case. Am Surg. 2005; 71: 184-186. [PMID: 16022022]
Alewine TC, Carter WR, Frew MJ. Congenital absence of the portal vein in a patient with urolithiasis. AJR Am J Roentgenol. 2007; 189: W150-152. [PMID: 17715083]
Ogul H, Bayraktutan U, Yalcin A, Turan MI, Ozgokce M, Eren S, Kantarci M. Congenital absence of the portal vein in a patient with multiple vascular anomalies. Surg Radiol Anat. 2013; 35: 529-534. [PMID: 23266872]
Pilgrim CH, Tsai S, Tolat P, Patel P, Rilling W, Evans DB, Christians KK. Optimal Management of the Splenic Vein at the Time of Venous Resection for Pancreatic Cancer: Importance of the Inferior Mesenteric Vein. J Gastrointest Surg. 2013. [PMID: 24347313]
Phillips BT, Pasklinsky G, Watkins KT, Vosswinkel JA, Tassiopoulos AK. Splenic vein turndown repair in superior mesenteric vein trauma: a reasonable alternative. Vasc Endovascular Surg. 2011; 45: 191-194. [PMID: 21156710]
Choi SH, Hwang HK, Kang CM, Lee WJ. Total Pancreaticoduodenectomy and Segmental Resection of Superior Mesenteric Vein-Portal Vein Confluence with Autologous Splenic Vein Graft in Mucinous Cystadenocarcinoma of the Pancreas. JOP. 2010; 9; 11: 638-641. [PMID: 21068503]
Suzuki K, Itano O, Oshima G, Osaku M, Asanuma F, Kitagawa Y. Modified laparoscopic splenic vessel-preserving distal pancreatectomy: matador assistance and peel-away technique. World J Surg. 2014; 38: 1205-1210. [PMID: 24305933]
Miyata M, Nakao K, Hirose H, Hamaji M, Kawashima Y. Reconstruction of portal vein with an autograft of splenic vein. J Cardiovasc Surg (Torino). 1987; 28: 18-21. [PMID: 3805105]
Ferrari V, Carbone M, Cappelli C, Boni L, Melfi F, Ferrari M, Mosca F, Pietrabissa A. Value of multidetector computed tomography image segmentation for preoperative planning in general surgery. Surg Endosc. 2012; 26: 616-626. [PMID: 21947742]
Copyright (c) 2014 Satheesha Nayak Badagabettu, Surekha D Shetty, Deepthinath Regunathan, Bincy M George, Snigdha Mishra, Srinivasa Rao Sirasanagandla
This work is licensed under a Creative Commons Attribution 4.0 International License.
As a member of Publisher International Linking Association, PILA, iMedPub Group’s JOP follows the Creative Commons Attribution License and Scholars Open Access publishing policies. Journal of the Pancreas is the Council Contributor Member of Council of Science Editors (CSE) and following the CSE slogan Education, Ethics, and Evidence for Editors.