title: 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.
abstract: BACKGROUND
  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.
authors.affiliation: Section of HPB Surgery, Department of Surgery, Washington University in Saint Louis, Saint Louis, MO 63110, USA. strasbergs@wustl.edu
authors.forename: Steven M
authors.initials: SM
authors.lastname: Strasberg
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Bhalla
authors.forename: Luis A
authors.initials: LA
authors.lastname: Sanchez
authors.forename: David C
authors.initials: DC
authors.lastname: Linehan
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000368:Aged; D014670:Ampulla of Vater / Q000601:surgery; D003097:Collateral Circulation; D003138:Common Bile Duct Neoplasms / Q000601:surgery; D003287:Contrast Media; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000503:physiopathology*; D021621:Imaging, Three-Dimensional; D008026:Ligation; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018919:Neovascularization, Physiologic; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000601:surgery; D010195:Pancreatitis / Q000601:surgery; D013154:Spleen / Q000098:blood supply* / Q000000981:diagnostic imaging; D013162:Splenic Vein / Q000601:surgery*; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media