Surgical treatment of gastric venous congestion in association with extended resection of pancreas: a case report

• Published in: BMC surgery Vol. 20; no. 1; p. 28
• Main Authors: Kagota, Shuji, Shimizu, Tetsunosuke, Taniguchi, Kohei, Tomioka, Atsushi, Inoue, Yoshihiro, Komeda, Koji, Asakuma, Mitsuhiro, Lee, Sang-Woong, Hirokawa, Fumitoshi, Uchiyama, Kazuhisa
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 10.02.2020; BioMed Central; BMC
• Subjects: Adenocarcinoma; Anastomosis; Bleeding; Cancer; Care and treatment; Case Report; Case reports; CAT scans; Computed tomography; Congestion; Diagnosis; Diagnostic imaging; Endoscopic ultrasonography; Gastric bypass; Gastric drainage vein; Gastric venous congestion; Hypertension; Pancreas; Pancreatectomy; Pancreatic cancer; Pancreaticoduodenectomy; Pancreatitis; Patients; Spleen; Stenosis; Stomach; Surgery; Tomography; Total pancreatectomy; Tumors; Ultrasound; Veins & arteries; Total pancreatectomy; Gastric venous congestion; Gastric drainage vein
• ISSN: 1471-2482; 1471-2482
• DOI: 10.1186/s12893-020-0692-4

Total pancreatectomy is performed for chronic pancreatitis, tumors involving the entire pancreas or remnant pancreas after pancreatectomy. Gastric venous congestion and bleeding may be associated with total pancreatectomy. We report the case of a patient who underwent left gastric vein to splenic vein bypass to relieve gastric venous congestion during total pancreatectomy for remnant pancreatic cancer. A 60-year-old woman underwent subtotal stomach-preserving pancreaticoduodenectomy for cancer of the pancreatic head. A follow-up computed tomography revealed a low-density tumor of the remnant pancreas. The pathological diagnosis was adenocarcinoma on endoscopic ultrasound-fine needle aspiration. Total resection of the remnant pancreas was performed for the tumor 3 years after the initial surgery. We ligated the splenic vein at the point of distal side of the left gastric vein confluent. Immediately, the vein congestion around the stomach was confirmed. We found the stenosis of the confluent between the left gastric vein and splenic vein. We subsequently anastomosed the left gastric vein and splenic vein, following which the gastric venous congestion was relieved. In cases wherein all the drainage veins from the stomach are removed, an anastomosis between the left gastric vein and splenic vein can be effectively used to prevent gastric venous congestion and bleeding after total pancreatectomy.