Abstract
BackgroundA case of a short circuit (Retzius shunt) from the inferior mesenteric vein (IMV) to the inferior vena cava (IVC) without accompanying portal hypertension due to liver cirrhosis is rare.Case presentationAn 83-year-old woman who was followed after surgery for thyroid and breast cancer was incidentally found to have rectal cancer on computed tomography (CT). Preoperative three-dimensional CT showed a venous malformation forming a short circuit (Retzius shunt) from the IMV to the IVC. Laparoscopic anterior rectal resection was performed. Operative findings included the Retzius vein crossing the abdominal aorta and the inferior mesenteric artery (IMA) to the IVC and a number of engorged vessels in the mesentery. The Retzius vein and IMA were clipped without major bleeding, and tumor-specific mesorectal excision was then performed. The patient’s postoperative clinical course was good, and she was discharged without complications.ConclusionsPreoperative imaging enabled identification of an unexpected rare disease, thus reinforcing the importance of preoperative imaging.
Highlights
A case of a short circuit (Retzius shunt) from the inferior mesenteric vein (IMV) to the inferior vena cava (IVC) without accompanying portal hypertension due to liver cirrhosis is rare.Case presentation: An 83-year-old woman who was followed after surgery for thyroid and breast cancer was incidentally found to have rectal cancer on computed tomography (CT)
The veins of Retzius are important, because they can be injured during surgery, and they may provide a pathway for the hematogenous spread of colorectal cancer
A case in which an unexpected Retzius venous short circuit between the IMV and IVC was discovered during three-dimensional computed tomography (3D-CT) prior to surgery is presented
Summary
The veins of Retzius are rare and may be primary (congenital or idiopathic) or secondary due to portal hypertension or trauma, or iatrogenic. A case in which an unexpected Retzius venous short circuit between the IMV and IVC was discovered during three-dimensional computed tomography (3D-CT) prior to surgery is presented. Using this information, laparoscopic anterior resection was safely performed. The 3D-CT scan showed a venous malformation forming a short circuit (Retzius shunt) from the IMV to the IVC (Fig. 3a, b). Based on these findings, upper rectal cancer with a Retzius shunt from the IMV to the IVC was diagnosed. The histological TNM staging of the tumor was stage IIIB, with no other remarkable findings
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