Superior mesenteric vein reconstruction during pancreatoduodenectomy using a dilated right ovarian vein in a patient at future risk for pelvic congestion syndrome: a case report

Yuki Takahashi; Kenichi Matsuo; Hideyuki Oyama; Ryuichi Sekine; Akihiro Nakamura; Tsuneyuki Uchida; Mikio Makuuchi; Kuniya Tanaka

doi:10.1186/s40792-022-01421-w

Superior mesenteric vein reconstruction during pancreatoduodenectomy using a dilated right ovarian vein in a patient at future risk for pelvic congestion syndrome: a case report

Surg Case Rep. 2022 Apr 13;8(1):67. doi: 10.1186/s40792-022-01421-w.

Authors

Yuki Takahashi¹, Kenichi Matsuo¹, Hideyuki Oyama¹, Ryuichi Sekine¹, Akihiro Nakamura¹, Tsuneyuki Uchida¹, Mikio Makuuchi², Kuniya Tanaka³

Affiliations

¹ Department of General and Gastroenterological Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan.
² Department of Surgery, Sannoudai Hospital, 4-1-38, Higashi-ishioka, Ishioka, Ibaraki, 315-0037, Japan.
³ Department of General and Gastroenterological Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan. u1792ts235@med.showa-u.ac.jp.

Abstract

Background: Pancreatoduodenectomy including resection of the superior mesenteric vein (SMV) is increasingly performed for right-sided pancreatic ductal adenocarcinoma invading the wall of that vessel. Various venous grafts may be chosen for reconstruction. We present a woman with pancreatic cancer who underwent such a pancreatoduodenectomy with venous reconstruction using a dilated right ovarian vein.

Case presentation: A 71-year-old woman with cancer involving the pancreatic head, uncinate process, and SMV underwent pancreatoduodenectomy with SMV resection. Reconstruction used a portion of the right ovarian vein that was markedly dilated and had placed her at risk for pelvic congestion syndrome (PCS). Graft patency was confirmed 8 months after surgery. She now finished receiving adjuvant chemotherapy and has no symptoms of PCS.

Conclusion: If an ovarian vein has sufficient diameter, it can be used to reconstruct the resected segment of the SMV during pancreatoduodenectomy in suitable patients.

Keywords: Pancreatoduodenectomy; Pelvic congestion syndrome; Superior mesenteric vein resection and reconstruction.