Abstract
Splenic vein ligation with superior mesenteric vein-portal vein confluence resection at the time of pancreatoduodenectomy may result in sinistral portal hypertension presenting with congestive gastric bleeding or a decreased platelet count due to hypersplenism. Two cases who underwent pancreatoduodenectomy with division of the splenic vein and creation of a splenorenal shunt to prevent this serious complication are described. The patients were 68 and 75-year-old woman, who both had locally advanced pancreatic ductal adenocarcinoma without any distant metastases. Subtotal stomach-preserving pancreatoduodenectomy including a distal splenorenal shunt was performed. Their postoperative courses were uneventful, and postoperative CT angiography showed good patency of the shunt without any findings of gastrosplenic congestion in both cases. The clinical significance of splenic vein ligation and sinistral portal hypertension remains controversial, but this condition has been emerging as a delayed and serious complication with potentially fatal consequences after pancreatoduodenectomy with resection of the mesenteric-portal vein confluence. Our early assessment shows that a distal splenorenal shunt is a safe and feasible procedure for avoiding sinistral portal hypertension after splenic vein ligation.
