Venous drainage from the tail of the pancreas to the lienal vein and its relationship with the distal splenorenal shunt selectivity

Piras, Cláudio; Paulo, Danilo Nagib Salomão; Paulo, Isabel Cristina Andreatta Lemos; Rodrigues, H; Silva, Alcino Lázaro da

doi:10.1590/s0102-86502010000100021

Cited by 4 publications

(5 citation statements)

References 13 publications

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“…However, it is better to perform angiography preoperatively and confirm the blood flow coming to the tail of the pancreas, because this procedure has a risk of inducing necrosis of the remnant pancreas. The venous drainage of the remnant pancreas was mainly thought to flow via the retroperitoneal small veins coming to the renal or adrenal veins [11], because we did not dissect the retroperitoneal tissues around the remnant pancreas in this case.…”

Section: Discussionmentioning

confidence: 99%

Pancreaticoduodenectomy with resection of the splenic artery and splenectomy for pancreatic double cancers after total gastrectomy. Preservation of the pancreatic function via the blood supply from the posterior epiploic artery: report of a case

et al. 2011

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The patient was a 56-year-old man who had previously undergone a total gastrectomy without splenectomy, and was diagnosed with pancreatic head and body cancers and primary solitary lung cancer. The pancreas body tumor invaded the origin of the splenic artery, and if the origin of the splenic artery were resected there would be no blood flow to the pancreas tail, resulting in a need for total pancreatectomy. However, we focused on the posterior epiploic artery (PEA), which is a less well known blood supply from the mesocolon to pancreatic body and tail, and planned to preserve the pancreatic tail as long as the resected margin of the pancreas was not malignant, considering his limited life expectancy. We performed a pancreaticoduodenectomy with resection of the origin of the splenic artery and splenectomy, preserving the pancreatic tail and PEA. The patient has been free from insulin therapy for blood sugar control, and has been well for 10 months after the surgery.

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Section: Discussionmentioning

confidence: 99%

Pancreaticoduodenectomy with resection of the splenic artery and splenectomy for pancreatic double cancers after total gastrectomy. Preservation of the pancreatic function via the blood supply from the posterior epiploic artery: report of a case

et al. 2011

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“…В 9 (20,4%) случаях помимо сосудов 1 типа были еще и сосуды 2 типа (1,1-1,5 мм), средний диаметр сосуда 1,3 (1,4) мм, при этом в 100% был один сосуд данного типа.…”

Section: поперечный срез пж на 5 см влево от края вбвunclassified

“…Доказано, что в данной области проходит, как правило, всего один крупный артериальный сосуд, представленный перипанкреатической артерией (ППА) [3]. Кроме того, в области перешейка ПЖ нет коротких венозных стволов, идущих из ткани железы к селезеночной вене, благодаря чему возможно выполнение безопасного туннелирования под ее перешейком [4]. При таких операциях как центральная и дистальные резекции ПЖ, трансплантация тела и хвоста ПЖ, ткань органа может пересекаться левее перешейка ПЖ [5].…”

Section: Introductionunclassified

The Choice of the Optimal Level of Intersection of the Pancreas Taking Into Account Variants of the Topography of Arterial Vessels and Pancreatic Duct

Tarasenko¹,

Tarakanov²,

Natalskiy³

et al. 2021

Novosti Khirurgii

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Objective. To determine the optimal level of intersection of the pancreas based on the features of the topography of the arterial vessels and the pancreatic duct of the isthmus and the body of the pancreas. Methods. 44 complexes of the upper floor of the abdominal cavity were studied. An injection mass with the subsequent fixation complexes in a formalin solution was introduced into the arterial vessels. The pancreatic tissue was crossed over the superior mesenteric vein along vertical lines drawn on one, two, three, four, and five cm to the left of the superior mesenteric vein. Depending on the diameter, the arteries were divided into the following types: 1 type (diameter - 0.5 - 1.0 mm); 2 type (diameter - 1.1 - 1.5 mm); 3 type (diameter more than 1.6 mm). The sections were used to assess the topography of the main tubular structures, the number and diameter of arterial vessels greater than 0.5 mm, the number of vessels of a certain type and the mean vessel diameter of this type. Results. On the cross - section above the superior mesenteric vein, as well as on the section made 1 cm to the left of it, vessels of type 1 (0.5-1.0 mm) prevailed. At the same time, two more pronounced arterial vessels were noted. These arteries were located, as a rule, extra-organically and had a relatively constant topography. The location of the pancreatic duct corresponded to the central part of the section. On transverse sections of the pancreas made along lines located from 2 cm to 5 cm to the left of the superior mesenteric vein; up to 5 arterial vessels were recorded.The location of the arterial vessels was inconsistent and did not have limited topographic zones. On sections from 2 to 5 cm to the left of the superior mesenteric vein, damage to the dorsal pancreatic artery was noted, and on sections 4 and 5 cm to the left of the superior mesenteric vein, a peripheral location of the pancreatic duct was found. Conclusion. The optimal level of intersection of the pancreas is the area above the superior mesenteric vein and 1 cm left of the superior mesenteric vein. What this paper adds It was revealed that the region of the pancreas from the superior mesenteric vein to 1 cm left of the superior mesenteric vein is considered to be the most optimal for transection of the pancreatic tissue from the anatomical point of view. Here, as a rule, two arterial vessels meet. It was found that the topography of these arteries is relatively constant, which makes it possible to suture them selectively.

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“…In 65.79 % anatomical pieces studied by Piras C et al, showed that the veins of the pancreatic tail flowed in segmentary branches of the splenic vein. These branches could be responsible for the loss of distal splenorenal shunt selectivity [1]. Since the portal system is valve less; retrograde flow through this siphon is possible; away from portal system to the shunt (Figure 1).…”

Section: What Is Exactly "Pancreatic Siphon"?mentioning

confidence: 99%

“…Of these Distal splenorenal shunt (DSRS) was found to provide long lasting solution to the problem. DSRS was based on the idea that esophageal and gastric varices will be decompressed into renal vein via short gastric vessels and spleen after disconnecting coronary vein at the same time maintaining hepatopetal flow in mesentericoportal circulation and supply of hepatotropic factors to liver [1]. But over time the shunt showed loss of this selectivity and showed increased rates of hepatic failure secondary to loss of portal flow from portal circulation to systemic circulation through peripancreatic and intra-pancreatic surgery.…”

Section: Introductionmentioning

confidence: 99%

Pancreatic Siphon: A Major Determinant of Selective Shunts. Is it a Historical Entity now?

Narkhede¹

2016

J Surg Surgical Res

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Surgical management of portal hypertension has changed according to time, evolving from just complete shunts to selective shunts and to liver transplantation. The outcomes also greatly improved owing to better understanding of portal hemodynamics and disease nature. Introduction of selective shunts showed promising results just to be challenged by poor outcome with development of "pancreatic siphon" which then studies in detail. This intra-pancreatic and peri-pancreatic collateral veins which connected portal and splenic veins formed basis of systemic loss of portal flow and thus ending up in failure of selectivity. Pancreatic siphon was found to be associated with increased rates of hepatic encephalopathy post selective shunting along with increased rates of hepatic failure. In addition to this pancreatic siphon led to metabolic sequel like new onset of diabetes, ischemic or compressive pancreatic ductopathy and intrapancreaic cholangiopathy. Although the shunting procedures are not that commonly done, pancreatic siphon has moved out of the limelight. It was just an attempt of recapping the existence of an unfamiliar entity forming delicate balance in the portal circulation. radicals connecting portal and splenic circulations [3]. Furthermore in response to pathology like portal venous thrombosis and splenic venous thrombosis these collaterlas tend to dilate and decompress respective compartments [3]. So development of pancreatic siphon is natural response of persistent elevated pressure in the mesentericoportal circulation over the intra-pancreatic and peri-pancreatic venous channels after splenic venous division and DSRS. Even such intra-pancreatic collaterals are seen in portal venous thrombosis with or without liver cirrhosis, without any clinically significant mass effect [4]. Ligation of coronary vein is a crucial step in creation of DSRS, failure of which can hasten the collateralisation and early formation of pancreatic siphon effect [5]. This intra-pancreatic collateral network along with coronary vein helps in decompressing gastrospenic compartment in inferior mesenteric-renal shunt which is a rare type of selective shunt [2]. The alcoholic patients, cirrhotics and post hepatitis patients were found to be specially prone for the development of pancreatic siphon [6], following selective shunts and porto-splenic thrombosis.

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Venous drainage from the tail of the pancreas to the lienal vein and its relationship with the distal splenorenal shunt selectivity

Cited by 4 publications

References 13 publications

Pancreaticoduodenectomy with resection of the splenic artery and splenectomy for pancreatic double cancers after total gastrectomy. Preservation of the pancreatic function via the blood supply from the posterior epiploic artery: report of a case

Pancreaticoduodenectomy with resection of the splenic artery and splenectomy for pancreatic double cancers after total gastrectomy. Preservation of the pancreatic function via the blood supply from the posterior epiploic artery: report of a case

The Choice of the Optimal Level of Intersection of the Pancreas Taking Into Account Variants of the Topography of Arterial Vessels and Pancreatic Duct

Pancreatic Siphon: A Major Determinant of Selective Shunts. Is it a Historical Entity now?

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