Surgical pitfalls of jejunal vein anatomy in pancreaticoduodenectomy.
BACKGROUND
Pancreaticoduodenectomy (PD) is the standard surgical procedure for treating pancreatic head cancers. Considerable knowledge of proximal jejunal and pancreatic vein anatomy is a prerequisite for performing PD surgery safely, yet there appear to be no detailed descriptions of first and second jejunal vein (J1V, J2V) anatomy available in the literature.


METHODS
Adults with hepatobiliary-pancreatic disease underwent multidetector-row computed tomography with intravenous contrast (n = 155), and SYNAPSE 3D (Fujifilm Medical, Tokyo, Japan) was used to generate 3D-CT images.


RESULTS
In 84% of patients, J1V and J2V formed a common trunk (FJT). There were three patterns of branches, related to the presence or absence of FJT formation and the anatomical relationships between the superior mesenteric artery (SMA) and the jejunal veins, as follows: Type 1 (n = 98, 63%) characterized by an FJT located dorsal to SMA; Type 2 (n = 32, 21%), where the FJT was located ventral to the SMA; and Type 3 (n = 25, 16%), where J1V and J2V each drained separately into the SMV.


CONCLUSIONS
J1V and J2V usually formed an FJT, and separate J1V and J2V drainage into the SMV was uncommon. Preoperative information on individual patient venous anatomy would increase the safety of the PD procedure.
Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Yoshiya
Y
Ishikawa
Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Daisuke
D
Ban
Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Satoshi
S
Matsumura
Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Yusuke
Y
Mitsunori
Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Takanori
T
Ochiai
Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Atsushi
A
Kudo
Department of Molecular Oncology, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Shinji
S
Tanaka
Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Minoru
M
Tanabe
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004066:Digestive System Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D004386:Duodenum / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007583:Jejunum / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008638:Mesenteric Arteries / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D008642:Mesenteric Veins / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D010179:Pancreas / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D055815:Young Adult
3D-CT; Elevated jejunum; Inferior pancreaticoduodenal vein; Jejunal vein; Pancreaticoduodenectomy