Anatomic Study Of Portal Vein. Transpancreatic Vessels Injuries Approach

Abstract

Introduction: The commitment of the great blood-vessels make up a situation of great complexity and a high rate of the complications and mortality patients with abdominal trauma. The injury of the portal vein matters because of the difficulty on the diagnosis and the approach surgery. Objective: To set the standard on the transverse section of the pancreas looking for a safer surgical access to repair the portal vein injuries. Methods: A quantitative analysis was performed to characterize the anatomical relationship between the portal vein and their tributaries relating them to the pancreas. On these corpses, the measurements of a anatomical triangle were studied. It base was the upper limit of the superior mesenteric vein and the initial portion of the portal vein; the apex, a point located on the upper limit of the confluence of the splenic vein and superior mesenteric vein, situated at the middle line of the superior mesenteric vein. Results: The portal vein is formed 3.24cm from the internal border of the duodenal arc at a distance of 1.61cm and 1.07 from the inferior and superior pancreas borders, respectively. Conclusion: The present study allow us to conclude that, to have access to the origin of the portal vein, in case of trauma of this vessel, one should proceed a transverse section of the neck of the pancreas next to the superior mesenteric vein, because its confluence with splenic vein occur, on average, 1.07cm and 1.61cm from the superior and inferior border of the gland, respectively.174225231Aleksandrovich, G.L., Rudenko, I.I., Injury of majors blood vessels in abdominal trauma (1991) Khirurgiia (Mosk), 12, pp. 66-69Dawson, D.L., Johansen, K.H., Jurkovich, G.J., Injuries to the portal triad (1991) Am J Surg, 161 (5), pp. 545-551Jurkovich, G.J., Hoyt, D.B., Moore, F.A., Ney, A.L., Morris, J.A., Scalea, T.M., Patcher, H.L., Davis, J.W., Portal triad injuries (1995) J Trauma, 39 (3), pp. 426-434Tyburski, J.G., Wilson, F.R., Dente, C., Steffes, C., Carlin, A.M., Factors affecting mortality rates in patients with abdominal vascular injuries (2001) J Trauma, 50 (6), pp. 1020-1026David Jr., J.K., Gomez, G.A., Trauma management (1989) Abdominal Vascular Trauma. 1 Ed., pp. 306-307. , David BP. Boston: Little Brown and CompanyHaimovici, H., Transperitoneal exposure of abdominal aorta and iliac arteries (1996) Vascular Surgery: Principles and Techniques. 4Ed., pp. 385-392. , Haimovici H. Cambridge: Blackwell SciencePetersen, S., Sheldon, G., Lim, R., Management of portal vein injuries (1979) J Trauma, 19, pp. 616-620Henne-Bruns, D., Kremer, B., Injuries of the portal vein and vena cava in severe blunt abdominal trauma (1992) Zentralbl Chir, 117 (6), pp. 343-347Henne-Bruns, D., Kremer, B., Lloyd, D.M., Meyer-Pannwitt, U., Injuries of portal vein in patients with blunt abdominal trauma (1993) HPB Surg, 6 (3), pp. 163-168Graham, D.D., May, A.K., Moore, M., Young, J.S., Management of hepatic artery injury: Case report (1997) Am Surg, 63 (4), pp. 327-329Jurkovich, G.J., Hoyt, D.B., Carrico, C.J., Pancreatic trauma (1990) Sug Clin North Am, 70 (3), pp. 575-593Machado, M.A.C., Volpe, P., Souza Jr., A.L., Poggetti, R.S., Branco, P.D., Birolini, D., Lesões traumáticas do pâncreas: Análise de 65 casos (1994) Rev Hosp Clin Fac Med S Paulo, 49 (6), pp. 238-242Patton Jr., J.H., Fabian, T.C., Complex pancreatic injuries (1996) Surg Clin North Am, 76 (4), pp. 783-795Goffi, F.S., Aspectos técnicos das ressecções pancreáticas (1991) Colégio Brasileiro de Cirurgiões - Cirurgia do Aparelho Digestivo. 11 Ed., pp. 143-146. , São Paulo: Robe EditoraMoore, K.L., (1994) Anatomia Orientada para a Clínica. 3 Ed., , Rio de Janeiro: Guanabara KooganTestut, L., Jacob, O., (1967) Tratado de Anatomia Topografica Com Aplicaciones Medicoquirurgicas. 8 Ed., pp. 135-149. , Barcelona: Salvat EditoresAlbu, I., Vaida, A., Briciu, M., Gherman, I., Oprea, A., Giurgiu, T., The portal vein and its main affluents. An anatomic and morphometric study (1982) Morphol Embryol (Bucur), 28 (4), pp. 267-272Falconer, C.W.A., Griffiths, E., Anatomy of the blood vessels in region of the pancreas (1950) Br J Surg, 37, pp. 334-339Correa, N.A., (1988) Clínica Cirúrgica. 4 Ed., pp. 559-562. , São Paulo: SarvierSteinman, E., Utiyama, E.M., Martini, A.C., Pogetti, R.S., Birolini, D., Lesão traumática da veia porta (1989) Rev Col Bras Cir, 16 (5), pp. 234-238Mantovani, M., Meirelles, G.V., Fraga, G.P., Abordagem cirúrgica do trauma pancreático e dos descolamentos retroperitoneais (2001) Terapêutica Cirúrgica. 1 Ed., pp. 688-696. , Petroianu A. Rio de Janeiro: Guanabara KooganPatcher, H.L., Liang, H.G., Hofstetter, S.R., (1996) Liver and Biliary Tract Trauma, pp. 487-523. , Feliciano DV, Moore EE, Mattox KL. Trauma. 3ed. Connecticut: AppletonSheldon, G.F., Lim, R.C., Yee, E.S., Management of injuries to the porta hepatis (1985) Ann Surg, 202 (5), pp. 539-54