Venous drainage from the tail of the pancreas to the lienal vein and its relationship with the distal splenorenal shunt selectivity

Cláudio Piras,Isabel Cristina Andreatta Lemos Paulo,Alcino Lázaro Da Silva,Hildegardo Rodrigues,Danilo Nagib Salomão Paulo

doi:10.1590/s0102-86502010000100021

Abstract

To identify the veins draining from the pancreatic tail to the lienal vein and its possible relationship with the loss of the distal splenorenal shunt selectivity. Thirty eight human blocks including stomach, duodenum, spleen, colon and pancreas, removed from fresh corpses, were studied with the replenish and corrosion technique, using vinilic resin and posterior corrosion of the organic tissue with commercial hydrochloric acid, in order to study the lienal vein and its tributaries. The number of veins flowing directly to the splenic vein varied from seven to twenty two (14.52 + or - 3.53). Pancreatic branches of the pancreatic tail flowing to the segmentary veins of the spleen were found in 25 of the anatomical pieces studied (65.79%). These branches varied from one to four, predominating one branch (60%) and two branches (24%). In 65.79% of the anatomical pieces studied, the veins of the pancreatic tail flowed in segmentary branches of the splenic vein. These branches could be responsible for the loss of distal splenorenal shunt selectivity. The complete disconnection of the pancreatic tail could increase the selectivity in this procedure.

Highlights

The increase in the portal system pressure leads to the formation of varices in esophageal and gastric region[1,2]
Among the used surgical procedures in the treatment of the portal hypertension, the venovenous anastomosis had been used with the objective of reduce the hipervolemia and the high pressure suffered by the portal system
From the thirty-eight anatomical pieces analyzed, all presented pancreatic branches draining into the splenic vein (Figure 2)

Summary

Introduction

The increase in the portal system pressure leads to the formation of varices in esophageal and gastric region[1,2]. The technique used the splenic vein, in its distal portion, anastomosing it with the left renal vein, in a terminal-lateral shape The objective of this new technique was the decompression of esophageal veins, through the short gastric veins and spleen, to a system of lower pressure (inferior vena cava system), preventing the diversion of the portal blood flow, from the liver to the systemic circulation. This reasoning, if valid, would prevent the loss of the portal blood flow and keep the flux of hepatotrophics substances to the liver[5]. The maintenance of the portal flow to the liver would allow the prevention of the encephalopathy, promote liver protection and keep a certain degree of venous hypertension in the portal system, with better protection of the shunt and reduction in the incidence of thrombosis

Methods

Results

Conclusion