Gastroepiploic Vein Research Articles

Morphology of portal hypertension at the early stage of liver damage induced by CCl4: an experimental study with dogs

To explore the morphological basis of portal hypertension happened at the early stage of liver damage. Sixteen mongrel dogs were injected intraperitoneally with carbon tetrachloride (CCl(4)) once a week for 4 weeks and then once every 4 days, totally for 7 weeks. Before the experiment and 7 weeks after the beginning of experiment, small pieces of liver tissues were taken through a median upper abdominal incision and underwent HE staining, Masson's staining, and immunohistochemistry with alpha-smooth muscle actin (alpha-SMA) to label the activated astrocyte (hepatic stellate cell, HSC), and transmission electron microscopy. The portal vein pressure was measured by puncture of gastroepiploic vein. The diameter of spleen was measure too. Since the second weeks after the experiment, the dogs showed vomiting, diarrhea, anorexia, weight loss, and varicose vein in the abdominal wall. One dog died of toxic enteritis 3 weeks after the beginning of experiment. 7 weeks after the injection of CCl(4), the average portal vein pressure of the rest 115 dogs was 22.7 cm H(2)O +/- 1.5 cm H(2)O, significantly higher than that before the experiment (12.2 cm H(2)O +/- 1.9 cm H(2)O, 1cm H(2)O = 0.098 kPa, P < 0.05). The long diameter of spleen of the 15 dogs was 24.4 +/- 3.1 cm, significantly greater than that before the experiment (18.7 cm +/- 2.4 cm, P < 0.05). Seven weeks after the injection of CCl(4) the appearance of liver did not change remarkably among the dogs, however, the spleens of the dogs showed swelling and stagnation of blood. No obvious ascites was seen. HE staining showed slight liver damage, such as fatty degeneration of liver cells; Masson's staining and electron microscopy showed typical sinusoid capillarization. alpha-SMA immunohistochemistry stain showed increased number of activated HSCs. Immunohistochemistry showed a number of alpha-SMA positive cells in the hepatic lobules. Portal hypertension was successfully induced in 15 dogs. At the early stage of liver damage the possible cause of portal hypertension is the increased resistance of blood stream due to sinusoid capillarization and activation of HSC.

Prevalence of Endotoxemia in Healthy Postparturient Dairy Cows and Cows with Abomasal Volvulus or Left Displaced Abomasum

Left displaced abomasum (LDA) and abomasal volvulus (AV) occur most commonly in postparturient dairy cows. Our main hypothesis was that endotoxemia occurred more frequently in the peripheral blood of cows with LDA or AV than in healthy cows because increased luminal pressure in AV or LDA, or the presence of a hemorrhagic strangulating obstruction in AV, may have injured the abomasal mucosa, thereby facilitating translocation of luminal endotoxin into the circulation. Therefore, our main objective was to compare the prevalence and magnitude of endotoxemia in healthy postparturient cows with the prevalence and magnitude of endotoxemia in cows with AV and LDA. We examined 60 adult dairy cows in early lactation that were diagnosed with AV (n = 15) or LDA (n = 15) or were healthy on physical examination (control group, n = 30). Jugular venous blood was obtained from cows in all 3 groups, and right gastroepiploic venous blood was obtained during surgical correction of AV and LDA immediately after repositioning of the abomasum. Platelet‐rich plasma endotoxin concentrations were measured with a chromogenic limulus amoebocyte lysate assay. Endotoxin was detected in jugular vein plasma in 50% (15/30) of control cows; however, the prevalence of endotoxemia was significantly lower (P&lt; .05) in cows with AV (7%, 1/15) or LDA (20%, 3/15). Endotoxin was detected simultaneously in right gastroepiploic and jugular vein plasma in only 1 cow with LDA and 0 cows with AV. Contrary to our hypothesis, we conclude that endotoxemia is infrequently present in postparturient dairy cows with AV or LDA.

Collateral venous pathways in the transverse mesocolon and greater omentum in patients with pancreatic disease.

The purpose of this study was to describe the radiologic findings of the collateral venous pathways in the transverse mesocolon and the greater omentum associated with pancreatic diseases and to correlate these venous pathways and the accompanying arterial anatomy. The collateral pathway in the transverse mesocolon consists of the inferior mesenteric vein, left transverse colic vein, marginal vein of the transverse colon, and middle colic vein. The pathway in the greater omentum consists of anastomosis of the left and right epiploic veins deriving from the gastroepiploic vein. The former pathway is the vena comitans of Riolan's arch and the latter is the vena comitans of the arch of Barkow.

Venous anatomy of the right colon: three-dimensional topographic mapping of the gastrocolic trunk of Henle

The gastrocolic trunk of Henle has not been described in detail in context with right hemicolectomy. The aim of this study was to define the caliber, length and three-dimensional position of the gastrocolic trunk of Henle (GTH). We studied 10 fresh (<24 h) cadavers. A corrosion cast method was employed. Cold polymerized methylacrylate was injected into the superior mesenteric vein (SMV) and artery. GTH diameter, length and point of confluence with the SMV were assessed. The GTH was present in all specimens originating from the confluence of the right gastroepiploic and superior-anterior pancreaticoduodenal veins. The GTH joined the SMV at an average distance of 2.2 cm (range, 1.6-3.2 cm) from the inferior pancreatic border and it coursed towards the right side in a ventral-cranial direction. The mean caliber and length of the GTH were 5.2 mm (range, 4.8-5.8 mm) and 16.1 mm (range, 10.1-20.7 mm), respectively. The GTH is a short, medium-sized vessel of potential clinical significance with a consistent ventral-cranial direction.

Patterns of collateral pathways in extrahepatic portal hypertension as demonstrated by multidetector row computed tomography and advanced image processing.

Pancreatic neoplasm can compromise the portal vein or its tributaries, resulting in extrahepatic portal hypertension. Collateral channels may develop, usually in a hepatopetal direction. These include gastroepiploic veins, short gastric veins, left gastric vein, left colic veins, and spontaneous splenorenal shunts. We present the spectrum of these collaterals as delineated by multidetector row computed tomography with advanced image processing. Delineation of these collaterals is important before surgery so as to avoid possible uncontrollable bleeding if they are inadvertently disrupted.

Extrahepatic portal hypertension treated by anastomosing inferior mesenteric vein to left portal vein at rex recessus

For the treatment of recurrent bleeding despite sclerotherapy or clinically significant hypersplenism, portosystemic shunt procedures should be performed in cases of extrahepatic portal hypertension caused by extrahepatic portal vein thrombosis. A novel alternative to portosystemic shunt procedures in extrahepatic portal hypertension is mesenterico-left portal bypass. Portal vein thrombosis is bypassed by an autologous vein graft (usually left internal jugular vein) interposed between superior mesenteric vein and left portal vein. In the presence of an enlarged right gastroepiploic vein, the distal end of this vein can be anastomosed to left portal vein without disturbing its proximal end. Herein, the authors report a case of extrahepatic portal hypertension treated by anastomosing enlarged inferior mesenteric vein to left portal vein to bypass portal vein thrombosis.

Configurational anatomy of the pancreas: its surgical relevance from ontogenetic and comparative-anatomical viewpoints

The structure of the adult human pancreas retains develop-mental traits in ontogenesis and comparative anatomy, under-standing of which greatly contributes to pancreatic surgical anatomy. The pyramidal process called the "auricle" or "ear"at the inferior margin of the neck suggests the vestige of the ontogenetic twist at the neck, resulting from bursal bulging with rotation of the pancreatic body and tail. This anatomical consideration serves to avoid inadvertent bleeding or pancreatic fistula during dissection of the right gastroepiploic arteryand vein at their roots. Recognition of embryonic rotation of the gastrointestinal tract eases detachment of the pancreati-coduodenal and jejunal vessels at their origins, enabling "reversed Kocherization" and complete resection of the mesoduodenum and upper mesojejunum. Embryological knowledge of vascular arcades of the pancreatic head serves as a guide for limited resection of the pancreas. The anterior inferior pancreaticoduodenal artery often runs behind, not in front of, the lower portion ("mentum" or "chin") of the pancreatic head, but still on the anterior leaflet of the embryonic mesoduodenum. The attachment of the adult pancreatic head to the duodenum occurs only at the major papilla of Vater and at the region around the minor papilla, which seems to be rational from ontogenetical and comparative-anatomical aspects. Knowledge of the pancreatic attachment helps when performing duodenum-preserving pancreatectomy and pancreas-sparing duodenectomy. The "lingula" or "small tongue", a pancreatic portion overlapping the common bile duct on the posterior aspect of the pancreas, is a key structure in resection of the extrahepatic bile duct.

Venous Anatomy of the Right Colon

PURPOSE: This study was designed to describe the precise venous anatomy of the right colon, which is especially important for laparoscopic right hemicolectomy. METHODS: Fifty-eight adult cadavers were dissected to define the three major venous tributaries of the right colon: the ileocolic vein, right colic vein, and middle colic vein. Two or three middle colic veins were often present, and the biggest one was designated as the main middle colic vein. The middle colic vein and the right colic vein occasionally formed a common trunk with the right gastroepiploic vein and/or the pancreaticoduodenal vein. This common trunk was defined as the gastrocolic trunk. RESULTS: All 58 cadavers had a single ileocolic vein. All of the ileocolic veins drained into the superior mesenteric vein. The right colic vein was absent in 56.9 percent (33/58), and the other 43.1 percent had a single right colic vein. The right colic vein joined the superior mesenteric vein directly in 56 percent (14/25) and the gastrocolic trunk in 44 percent (11/25). The middle colic vein was the most variable. A single middle colic vein was present in 37.9 percent (22/58), 2 middle colic veins were present in 50 percent (29/58), and 3 middle colic veins were present in 12.1 percent (7/58). The main middle colic vein drained into the superior mesenteric vein directly in 84.5 percent (49/58), whereas 12.1 percent (7/58) drained into the gastrocolic trunk. In two cadavers, there was anomalous drainage of the main middle colic vein to the splenic vein and the inferior mesenteric vein. Forty-three accessory middle colic veins were present in total. These drained into the superior mesenteric vein in 17 cadavers and into the gastrocolic trunk in 23. The gastrocolic trunk was present in 69 percent (40/58), being formed with the right colic vein in 27.5 percent (11/40; 1 was together with an accessory middle colic vein) and with the middle colic vein in 75 percent (30/40; 7 with the main middle colic vein, 23 with the accessory middle colic vein). CONCLUSION: Venous anatomy of the right colon is highly variable. It is especially important to recognize the lack of direct drainage of the right colic vein to the superior mesenteric vein and the high frequency of the presence of plural middle colic veins and the gastrocolic trunk.

Venous anatomy of the right colon: precise structure of the major veins and gastrocolic trunk in 58 cadavers.

This study was designed to describe the precise venous anatomy of the right colon, which is especially important for laparoscopic right hemicolectomy. Fifty-eight adult cadavers were dissected to define the three major venous tributaries of the right colon: the ileocolic vein, right colic vein, and middle colic vein. Two or three middle colic veins were often present, and the biggest one was designated as the main middle colic vein. The middle colic vein and the right colic vein occasionally formed a common trunk with the right gastroepiploic vein and/or the pancreaticoduodenal vein. This common trunk was defined as the gastrocolic trunk. All 58 cadavers had a single ileocolic vein. All of the ileocolic veins drained into the superior mesenteric vein. The right colic vein was absent in 56.9 percent (33/58), and the other 43.1 percent had a single right colic vein. The right colic vein joined the superior mesenteric vein directly in 56 percent (14/25) and the gastrocolic trunk in 44 percent (11/25). The middle colic vein was the most variable. A single middle colic vein was present in 37.9 percent (22/58), 2 middle colic veins were present in 50 percent (29/58), and 3 middle colic veins were present in 12.1 percent (7/58). The main middle colic vein drained into the superior mesenteric vein directly in 84.5 percent (49/58), whereas 12.1 percent (7/58) drained into the gastrocolic trunk. In two cadavers, there was anomalous drainage of the main middle colic vein to the splenic vein and the inferior mesenteric vein. Forty-three accessory middle colic veins were present in total. These drained into the superior mesenteric vein in 17 cadavers and into the gastrocolic trunk in 23. The gastrocolic trunk was present in 69 percent (40/58), being formed with the right colic vein in 27.5 percent (11/40; 1 was together with an accessory middle colic vein) and with the middle colic vein in 75 percent (30/40; 7 with the main middle colic vein, 23 with the accessory middle colic vein). Venous anatomy of the right colon is highly variable. It is especially important to recognize the lack of direct drainage of the right colic vein to the superior mesenteric vein and the high frequency of the presence of plural middle colic veins and the gastrocolic trunk.

Leiomyosarcoma arising from the superior mesenteric vein

Surgery 2002;132:108-9.

Hématémèse révélatrice du volvulus chronique d’une rate baladeuse

A 23 years old woman was admitted on emergency for an upper digestive tract bleeding and endoscopy found gastric varices. CT scan revealed a splenomegaly, a twisted aspect of the splenic pedicle and varices in the gastrosplenic ligament. Arteriography showed a narrow splenic artery and varices in the gastrosplenic ligament. After a recurrent bleeding, splenectomy was performed. There was a chronic volvulus of a wandering spleen; the splenic venous flow was passing through the left gastroepiploic vein and a gastrosplenic vein. Chronic volvulus of a wandering spleen with gastric varices is an unfrequent pathology, diagnosed by imaging and requiring splenectomy.

Transplantation of the en bloc vascular system for coronary revascularization

Objectives: Use of the free gastroepiploic artery graft for coronary revascularization has not been very popular because of its inclination toward vasospasm. We hypothesized that the cause of free gastroepiploic artery spasm was the graft damage caused by an interruption of venous drainage from the graft. To solve this problem, we developed a new method of free gastroepiploic artery grafting. Methods: From January 1997 to October 1999, 33 patients underwent coronary artery bypass grafting with the free gastroepiploic artery according to our new method. The gastroepiploic artery graft was harvested en bloc with its satellite veins. The gastroepiploic vein was anastomosed to the right atrial appendage for venous drainage simultaneously with the gastroepiploic artery being grafted in the aortocoronary position. Results: A total of 96 distal anastomoses were performed, including 33 free gastroepiploic artery grafts according to our method, 33 in situ left internal thoracic artery grafts, 26 saphenous vein grafts, and 4 radial artery grafts. Neither operative nor hospital death occurred. Early postoperative angiography revealed that all of the 33 free gastroepiploic artery grafts performed with our method were patent without spasm, and flow competition occurred only in 2 of those grafts. On late angiography, all 15 free gastroepiploic artery grafts were patent without spasm. Conclusions: The free gastroepiploic artery grafting with venous drainage technique we developed can prevent graft spasm, leading to improved patency rate. (J Thorac Cardiovasc Surg 2001;121:520-5)

Configuração do sistema venoso portal na cutia (Dasyprocta aguti, RODENTIA)

The study of portal vein concerning the confluent vessels to its formation and its tributaries was carried out in adult agouties (3 females and 7 males), the venous system of which was infected with colored latex and fixed in 10% formol. After dissection, it was noted that the trunk of the portal vein has its origin in the confluence of two roots, represented in 90% of the cases, by the lienal vein and by the common mesenteric trunk, composed by cranial and caudal mesenteric veins and, in 10%, by lienal vein and by cranial mesenteric vein. The trunk of the portal vein has as its tributaries the cranial pancreaticoduodenal vein (100%), the right gastric vein (90%), and the right gastroepiploic vein (40%).

Surgical anatomy of the pancreas for limited resection.

The fusion fascia of the head of the pancreas is called the "fusion fascia of Treitz" and that of the body and tail of the pancreas is termed the "fusion fascia of Toldt". The fusion fascia is histologically composed of a loose connective tissue membrane. All of the important pancreaticoduodenal arcades of arteries and veins are situated on this membrane, i.e., between this membrane and the pancreatic parenchyma. The topography of the head of the pancreas shows that, after departing from the gastroducodenal artery, the anterior superior pancreaticoduodenal artery runs toward a point 1.5 cm below the papilla of Vater, then turns to the posterior aspect of the pancreas to join the anterior inferior pancreaticoduodenal artery. For preserving the duodenum, the artery toward the papilla is very important. The artery toward the papilla of Vater runs along the right side of the common bile duct after departing from the posterior superior pancreaticoduodenal artery. The gastrocolic trunk of Henle has been reported to be found in about 60% of individuals. It is possible that the gastroepiploic vein and anterior superior pancreaticoduodenal vein (ASPDV) can be divided at pancreaticoduodenectomy, with preservation of the superior right colic vein, if this area is free of carcinoma. The ASPDV and anterior inferior pancreaticoduodenal vein form an arcade on the anterior surface of the pancreas. However, arcade formation was not found between the posterior superior pancreaticoduodenal vein and posterior inferior pancreaticoduodenal vein in many of the individuals examined. The vein joined by the inferior mesenteric vein was also investigated.

The risks of total pancreatectomy and splenic islet autotransplantation.

The intraportal site is the most common site for islet transplantation. Many other sites have been tried experimentally, including the spleen, which has successfully lead to insulin independence in a number of animal models. Nevertheless, there are no detailed reports of total pancreatectomy and splenic islet autotransplantation in humans. Five patients underwent total pancreatectomy and splenic islet autotransplantation for chronic pancreatitis. Four patients had a pylorus-preserving total pancreatectomy and one patient a duodenal-preserving pancreatectomy. In three cases islets were embolized into both the portal vein and spleen. Two patients received splenic islet transplants alone. Islets were transplanted by retrograde venous infusion via the short gastric veins (n = 3), splenic vein stump (n = 1), and the left gastroepiploic vein (n = 1). The total volumes of transplanted pancreatic digest in those receiving combined intraportal and splenic autografts (n = 3) were 15.8, 13.0, and 13.5 ml. The volumes in those receiving a splenic-alone autograft (n = 2) were 12.0 and 5 ml. The mean rise in portal pressure was 18 cm of water. Complications related to the splenic autograft included a wedge splenic infarct, an emergency splenectomy, and a portal vein thrombosis in one patient having a combined intraportal and splenic autograft. Two patients developed insulin independence. two patients were still insulin independent at 1-year follow-up, and all had normal HbA1c levels (mean 5.6, range 5.2-6.3). Splenic islet autotransplantation, after total pancreatectomy, does lead to insulin independence. However, in our experience the combined procedure has a high morbidity because of splenic infarction and venous thrombosis.

Regulation of fundic and antral somatostatin secretion by CCK and gastrin.

CCK and gastrin stimulate somatostatin (SOM) secretion and thus modulate their direct effects on the parietal cell. Although SOM is stored in D cells of the fundus and antrum, the nature of the cell type differs, and it is not known whether both regions respond to the stimulatory effects of CCK and gastrin. The objectives of the present study were to determine the separate effects of CCK and gastrin on fundic and antral SOM secretion and to assess the type of receptor involved, using CCK-A (L-364,718) and CCK-B/gastrin (L-365,260) receptor antagonists. Changes in SOM were measured in plasma collected from cannulas draining blood from the fundus (gastric vein) and antrum (gastroepiploic vein) in anesthetized sheep. Both CCK and gastrin significantly stimulated SOM from the fundus and antrum. Sulfated CCK-8 (CCK-8S) increased SOM secretion from the fundus and antrum through interaction with both type A and B receptors. In contrast to CCK-8S, sulfated gastrin-17 (G-17S) stimulated SOM from the fundus via the type B receptor alone, whereas in the antrum G-17S stimulated SOM secretion independent of the A and B receptors. Histamine mediated, at least in part, the SOM-stimulatory effects; an H2-receptor antagonist blocked CCK-stimulated SOM secretion in both the fundus and antrum and reduced gastrin-stimulated SOM secretion in the fundus. The present study demonstrates regionally distinct regulatory mechanisms for gastric SOM secretion by CCK and gastrin.

A DISTAL GASTRECTOMY FOR CARCINOMA DEVELOPED IN THE RECONSTRUCTED GASTRIC TUBE 13 YEARS AFTER ESOPHAGECTOMY FOR THORACIC ESOPHAGEAL CANCER -A CASE REPORT-

We report a resected case of carcinoma developed in the reconstructed gastric tube 13 years after esophagectomy for a thoracic esophageal cancer. In February, 1984, he underwent a subtotal esophagectomy and an intrathoracic esophagostrostomy for an early carcinoma in the middle intra-thoracic esophagus (Im). The tumor was superficial and flat type, 2.0×1.5cm in size, and microscopically squamous cell carcinoma (sec) with m, n0, v0, ly0, and in stage 0. Since September, 1996 he had experienced chest discomfort and appetite loss. He visited the department of internal medicine in our hospital, and a pace maker was implanted for sick sinus syndrome in February, 1997. The symptom was not improved and an endoscopic examination showed a gastric carcinoma of type 5 in the lesser curvature of the antrum. So he was referred to the department in March, 1997. Preserving the right gastroepiploic artery and vein, a distal gastrectomy and a Roux-en-Y anastomosis for the remnant stomach and jejunum were performed. Histologically, the tumor was well-differentiated adenocarcinoma with tubl, ss, n(-), ly1, v1, in stage Ib. As of 12 months after the operation, the patient is disease-free without an signs of recurrence. Some bibliographical notes on 65 cases of carcinoma in the gastric tube reconstructed after esophagectomy in Japan are also presented.

Experimental investigation of the role of the splenic vein in gastric venous obstruction after pylorus-preserving pancreatoduodenectomy in the dog.

This study showed that the splenic vein (SV) plays a major role in maintaining gastric blood flow after ligature of peripyloric vessels in the dog. Therefore, SV preservation or alternative venous drainage may be recommended to maintain sufficient gastric blood flow in pylorus-preserving pancreatoduodenectomy (PPPD). In PPPD, we often encounter the problem of gastric venous drainage obstruction, if the splenic-portal vein confluence needs to be resected. This study investigated significance of venous drainage via the left gastric and splenic veins in gastric tissue blood flow. In seven mongrel dogs, gastric tissue blood flow was measured by both laser Doppler flowmetry (LDF) in the antrum and hydrogen gas clearance (HGC) in the antrum and body. Blood flow was measured after the following treatments: 1. No treatment; 2. Duodenal transection; 3. Ligature of the right gastric and gastroepiploic arteries and veins; 4. Transient obstruction of the left gastric vein (LGV); 5. Transient obstruction of the SV with the LGV open; and 6. Obstruction of both the LGV and the SV. As judged by LDF, treatments 2, 3, and 4 did not decrease blood flow, but treatments 5 and 6 significantly decreased it compared with both treatments 1 and 3. By HGC, changes in the antrum and the body were parallel. Duodenal transection did not, but treatments 3 and 4 did decrease blood flow compared with no treatment. Obstruction of the left gastric vein did not, but treatments 5 and 6 did significantly decrease it compared with treatment 3.

WONDERING DOUBLE ACCESSARY SPLEEN-REPORT OF A RESECTED CASE-

This paper describes a rare case of double accessary spleen locating in the fairly distant omentum and presenting with symptoms due to tortion of the pedicle, with a review of the literature. A 35-year-old woman was admitted to the hospital for close examination because she was pointed out having a tumor in the left flank at a medical checkup. Abdominal ultrasonography revealed a solid tumor in the left tail side of the kidney. Abdominal CT visualized posterior displacement of the descending colon by a homogenous solid tumor which originated from the inferior pole of the kidney. Angiography revealed a hypervascular tumor fed by the left gastroepiploic artery and another hypervascular multiple lesion with the size of 2 cm in diameter in the vicinity of the inferior pole of the spleen. Accessary slpeen was suspected, but a possibility of some malignant disease could not be ruled out. In addition the patient had intermittent attack of colicky abdominal pain, and then she was operated on. On laparotomy there were an accessary spleen 40 mm in diameter with pedicle 90 mm in length and another accessary spleen 21 mm in diameter with pedicle 25 mm in length which were connected to the gastroepiploic artery and vein. Both accessary spleens were excised at the each origin. Histologically both tumors were accessary spleen.

A communication between the gastroepiploic artery and vein in the pedicle

A communication between the gastroepiploic artery and vein in the pedicle