Illustration of SMV and SMPV resection. (SMV: superior mesenteric vein; SMPV: superior mesenteric portal vein confluence; SV: splenic vein; PV: portal vein).

Illustration of SMV and SMPV resection. (SMV: superior mesenteric vein; SMPV: superior mesenteric portal vein confluence; SV: splenic vein; PV: portal vein).

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62 year old Caucasian female with pancreatic head mass abutting the superior mesenteric vein (SMV) presented with fine needle aspiration biopsy confirmed diagnosis of ductal adenocarcinoma. CT scan showed near complete obstruction of portal vein and large SMV collateral development. After 3 months of neoadjuvant therapy, her portal vein flow improv...

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... This patient received PD+PVR for cancer of the pancreatic head and developed PV stenosis at the point of PV reconstruction postoperatively. However, no ascites was observed before CRC surgery, possibly because of the development of collateral circulation around the SMV 16,17) . The patient developed refractory ascites after CRC surgery, which might have been induced by the dissection of collateral vessels during CRC surgery. ...
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Objectives: Colorectal cancer (CRC) surgery after pancreaticoduodenectomy (PD) is difficult to perform, because PD involves dissection and complex reconstruction of the digestive tract. We evaluated the clinical outcomes of CRC surgery in patients with prior PD. Methods: Between January 2008 and March 2018, a total of 1727 patients received CRC surgery at our institution. Of these, 10 had previously undergone PD (PD group). As a control group, 280 patients were collected who had undergone resection without any history of previous abdominal surgery. The PD and control groups were further subdivided into four groups by right or left side. Outcomes of colorectal surgery were investigated in the PD and control groups. Results: The number of harvested lymph nodes was significantly lower in the PD group. In the right colectomy group, distance from the surgical margin was significantly shorter in the PD group. The rate of postoperative complications was higher in the PD group. Peritoneal dissemination originating from pancreatic cancer was found during CRC surgery for one patient, and one patient developed refractory ascites. Three patients died of pancreatic cancer, rectal cancer, and other disease. Seven patients were alive without recurrence. Conclusions: CRC surgery for patients with prior PD can involve difficulty in dissecting lymph nodes and higher postoperative morbidity rates but can provide sufficiently curative resection for CRC.
... As SMV thrombosis was observed before the surgery, venous drainage of the small bowel was ach ieved via the lower mesenteric and splenic veins, and reconstruction of the SMV was not necessary. PD with SMV resection and without reconstruction was performed in two another cases, as described by Hashimoto et al [5] , Figure 1 Initial computed tomography scan, axial section: Tumor of the pancreatic head (green arrow) with adjacent thrombus of the superior mesenteric vein (red arrow) after confirming adequate PV flow and no small intestine congestion, and by Tang et al [6] , who performed the same operation with anastomosis between the splenic vein and PV without SMV reconstruction. ...
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We report the case of a 56-year-old woman with pancreatic adenocarcinoma (PA) discovered during an episode of febrile jaundice. A computed tomography (CT) scan showed a mass in the head of the pancreas with circumferential infiltration of the superior mesenteric vein (SMV) and dilatation of the biliary and pancreatic ducts without metastases. The patient benefited from neoadjuvant chemotherapy (FOLFIRINOX) followed by radio-chemotherapy (45 Gy) and chemotherapy (LV5FU2). The revaluation CT revealed SMV thrombosis without portal vein (PV) thrombosis. There was no contact of the tumor with the PV. Pancreatoduodenectomy with combined resection of the SMV was performed with no reconstruction of this venous axis after confirmation of adequate PV, splenic, and left gastric venous flow and the absence of bowel ischemia. The pathological diagnosis was pT4N1R0 PA. There were no bowel angina issues during the follow-up period. At 15 mo after surgery, the patient died of metastatic recurrence.
... In this case, the collateral vessels can ensure normal venous return for abdominal organs after resecting the SMV. A similar finding had been reported in a pancreaticoduodenectomy, despite possibly causing lethal consequences [4] . Therefore, the preferred choice of operation was surgical removal of the liposarcoma and invaded SMV. ...
... It is rare that vascular revascularization is not performed after the surgical removal of the SMV. Only one case in the previous literature reported use of this technique [4] . That patient was diagnosed with pancreatic head tumor and had formed multiple collateral circulations. ...
... Moreover, anastomotic thrombosis caused by revascularization is another postoperative complication. Previously, ligation of the SMV during pancreaticoduodenectomy due to anastomosis of the portal and splenic veins in a desperate situation that decompressed the mesenteric venous system was reported [4] . This study produced an interesting surgical option of deliberately breaking the SMV in cases where the SMV had been eroded. ...
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A 61-year-old female patient with chronic hepatitis B virus infection was diagnosed with liposarcoma in a community hospital. Fine needle aspiration biopsy confirmed the diagnosis of well-differentiated liposarcoma. Abdominal computed tomographic angiography (CTA) showed that the mass adhered to and constricted the main trunk and branch of the superior mesenteric vein (SMV), especially the ileocolic vein, and collateral circulation was observed during the vascular reconstruction scan. The abdominal liposarcoma was resected. Because of the collateral circulation, devascularization of the SMV was attempted, and we resected the eroded SMV. The condition of the blood vessels was evaluated 20 d after surgery using CTA, which showed that the SMV had disappeared. Significant improvements in SMV collateral circulation and the inferior mesenteric vein were observed after vascular reconstruction. The patient had an uneventful postoperative course except for transient gastroplegia. Twenty months after surgery, the patient had a recurrence of liposarcoma. She underwent tumor resection to remove the distal small intestine and right hemicolon. We learned that (1) direct devascularization of the main SMV trunk without a vein graft is possible. The presence of collateral circulation can increase the success rate of patients undergoing radical surgery and prevent the occurrence of serious postoperative complications. In addition, (2) this case demonstrated the clinical value of 3D reconstruction.
... Variations or upper part of SMV or its tributaries might cause postoperative jejunal ischemia [4]. Superior mesenteric-portal vein confluence resection is done during pancreaticoduodenectomy [8]. Variations of SMV or its tributaries might result in arterio-venous fistula during surgery or endovascular treatments. ...
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During our dissection classes, we saw a venous collar formed around the superior mesenteric artery (SMA) by the jejunal tributaries of superior mesenteric vein in an adult male cadaver. The jejunal tributaries united themselves to form two common jejunal veins. Upper common jejunal vein crossed superficial to SMA and opened into the SMV in front of the uncinate process of pancreas. The inferior common jejunal vein crossed behind the SMA from left to right and opened into the SMV, 4 cm below this level. A communicating vein connected the two common jejunal veins with each other.
Article
A 60-year-old woman was diagnosed with locally advanced non-resectable pancreatic cancer due to superior mesenteric vein (SMV) involvement. Invasion with SMV narrowing was detected on the peripheral side of the middle colic vein (MCV) and inferior mesenteric vein (IMV), and collateral circulation to the MCV and IMV developed. Since no collateral vein was detected during the operation, pancreaticoduodenectomy was performed without SMV reconstruction. After the operation, the patient developed chylorrhea and was discharged from hospital 34 days after surgery. A rare case of pancreaticoduodenectomy without SMV reconstruction is presented along with a review of the literature.