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01-05-2014 | Original Article

Optimal Management of the Splenic Vein at the Time of Venous Resection for Pancreatic Cancer: Importance of the Inferior Mesenteric Vein

Authors: Charles H. C. Pilgrim, Susan Tsai, Parag Tolat, Parag Patel, William Rilling, Douglas B. Evans, Kathleen K. Christians

Published in: Journal of Gastrointestinal Surgery | Issue 5/2014

Abstract

Background

Resection of the superior mesenteric vein (SMV)-portal vein (PV)-splenic vein (SV) confluence during pancreatectomy for pancreatic cancer requires management of the SV.

Discussion

Simple SV ligation can result in sinistral portal hypertension if the inferior mesenteric vein (IMV) enters the confluence and is thereby resected, or if the IMV is insufficient to drain the SV. We describe herein three patients whose clinical course confirms the importance of the IMV decompressing the SV to avoid sinistral hypertension.

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Christians KK, Riggle K, Keim R, et al. Distal splenorenal and temporary mesocaval shunting at the time of pancreatectomy for cancer: Initial experience from the Medical College of Wisconsin. Surgery. 2013;154(1):123-31.PubMedCrossRef

Strasberg SM, Bhalla S, Sanchez LA, Linehan DC. 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. J Gastrointest Surg. 2011;15(11):2070-2079.PubMedCrossRef

Koklu S, Coban S, Yuksel O, Arhan M. Left-sided portal hypertension. Dig Dis Sci. 2007;52(5):1141-1149.PubMedCrossRef

Warren WD, Zeppa R, Fomon JJ. Selective trans-splenic decompression of gastroesophageal varices by distal splenorenal shunt. Ann Surg. 1967;166(3):437-455.PubMedCentralPubMedCrossRef

Warren WD, Fomon JJ, Zeppa R. Further evaluation of selective decompression of varices by distal splenorenal shunt. Ann Surg. 1969;169(5):652-660.PubMedCentralPubMedCrossRef

Title: Optimal Management of the Splenic Vein at the Time of Venous Resection for Pancreatic Cancer: Importance of the Inferior Mesenteric Vein
Authors: Charles H. C. Pilgrim
Susan Tsai
Parag Tolat
Parag Patel
William Rilling
Douglas B. Evans
Kathleen K. Christians
Publication date: 01-05-2014
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 5/2014
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-013-2428-6

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Springer Medicine

Optimal Management of the Splenic Vein at the Time of Venous Resection for Pancreatic Cancer: Importance of the Inferior Mesenteric Vein

Abstract

Background

Discussion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Discussion

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