Abstract
A 65-year-old woman underwent subtotal, stomach-preserving pancreatoduodenectomy with combined resection of the portal vein and superior mesenteric vein following preoperative chemoradiotherapy for carcinoma of the head of the pancreas. During surgery, the splenic vein and inferior mesenteric vein were resected, and marked congestion was seen throughout the stomach immediately after additional resection of the left gastric vein. It was thought that this was caused by stagnation in the left portal system, and an end-to-side anastomosis between the right gastroepiploic vein and inferior mesenteric vein was performed, which resulted in immediate improvement of gastric congestion. Contrast-enhanced computed tomography (CT) taken on postoperative day 5 showed development of collateral blood flow as follows : right gastroepiploic vein → anastomotic site → inferior mesenteric vein →left colic vein → marginal middle colic vein → middle colic vein. The patient was discharged postoperatively without delayed gastric emptying or other problems, and no symptoms such as gastrointestinal bleeding have occurred since then. The present case is reported as it suggests that anastomosis between the right gastroepiploic vein and inferior mesenteric vein is effective for marked gastric congestion during combined resection of the portal vein and superior mesenteric vein.
