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Portal Vein Reconstruction Using an Autologous Splenic Vein Graft at the Superior Mesenteric and Portal Vein Confluence during Pancreaticoduodenectomy

Junichi Matsui, Yutaka Takigawa

Context We report the case-report regarding a patient with cancer of the pancreatic uncinated process who undertook vascular reconstruction of the portal vein using an autologous splenic vein graft at the superior mesenteric and portal vein confluence during pancreaticoduodenectomy. Case report A seventy-six-year-old woman was found to have pancreatic head cancer when abdominal computed tomography (CT) was performed for urinary occult blood. CT revealed a large tumor with poor contrast effect in the uncinated process of the pancreas, the patency of the main trunk of the portal vein (PV) and the splenic vein (SPV), and the total occlusion of the superior mesenteric vein. The patient underwent resection of PV during PD and subsequent vascular reconstruction using an autologous SPV graft at the SMPV confluence. The postoperative course was uneventful. The postoperative left-sided portal hypertension due to non-reconstruction of the SPV was concerning; however, postoperative CT imaging showed no evidence of gastrointestinal congestion, splenomegaly, thrombus, or ascites. A follow-up CT imaging at the 15th postoperative month showed a patent splenic vein graft. Conclusion Splenic vein interposition grafting should be considered in a case of pancreaticoduodenectomy with resection of the SMPV confluence