1956 Volume 64 Issue 2 Pages 137-142
The collateral circulation is established within 1-2 weeks in experimental animals after obstruction of the portal vein. These animals had no operation except on splenic vein and superior pancreatico-duodenal vein. In patients subjected to pancreaticoduodenectomy for carcinoma of the pancreas or bile duct, the collateral formation was relatively limited by resection of the tumor with half of the stomach, most part of the duodenum, half of the pancreas and common bile duct. As already being shown by Edwards, 2) accessory portal veins in human beings are important in establishment for collaterals toward the liver. It seems important to preserve the vessels around the hepatic portae as far as no carcinomatous infiltration exists. Though (12), (13) & (14) in table I are not described in the literature, they do not seem to play an important role as portal collaterals. Veins described by Retzius1) is important when superior mesenteric vein is obstructed. (9) seems to have been built by the pressure difference of the bed of gastrosplenic vein and mesenteric veins during the operation. The collateral vessels (superior haemorrhoidal vein middle haemorrhoidal vein-venules in the pelvis-spermatic vein) described by Retzius were not discovered by the author.
The collaterals (a) Portal vein -paraumbillical vein in the abdominal wall, i.e. Caput Medusae; (b) Sappey's vein3) -diaphragmatic veins did not appear. The reason that varix in the esophagus was not noticed is probably due to the small amount of blood flow in the esophageal vein, because the veins leading to it are cut at the operation when the portal vein is transplanted.
