Evaluation of the venous drainage pattern of the splenic flexure by preoperative three‐dimensional computed tomography

Abstract

Introduction Anatomical evaluation of the splenic flexure vein is essential for complete mesocolic excision with central vascular ligation when treating patients with splenic flexure cancer. Although there have been several studies relating to the arterial branches of the splenic flexure, very limited data are available regarding the variation in venous anatomy in this region. Methods Sixty‐six patients with colorectal cancer who underwent preoperative 3‐D CT between April 2016 and April 2017 were included in this retrospective study. The pattern of the venous drainage of the splenic flexure and its association with the inferior border of the pancreas were evaluated. Results The inferior mesenteric vein flowed into the splenic vein in 32 patients (48.5%), into the superior mesenteric vein in 27 patients (40.9%), and into the confluence of splenic vein and superior mesenteric vein in 7 patients (10.6%). The splenic flexure vein joined the inferior mesenteric vein in 62 patients (93.9%), the splenic vein in 2 patients (3.0%), and the middle colic vein in 2 patients (3.0%). The splenic flexure vein flowed into the inferior mesenteric vein below the level of the inferior border of the pancreas in 58 patients (90.6%) and above it in 4 patients (6.3%). Conclusion Preoperative evaluation of the venous pattern of the splenic flexure on 3‐D CT is useful before complete mesocolic excision with central vascular ligation to avoid intraoperative bleeding during splenic flexure cancer surgery.

Vascular anatomy of the splenic flexure, focusing on the accessory middle colic artery and vein

“…The origin of the AMCA and the destinations of the IMV and SFV were on the dorsal side of the pancreas in 15 (20.2%), 65 (31.7%) and 8 (3.9%) of patients, respectively. This result is consistent with that of previous studies . In patients with gastric cancer, the positional relationship between the splenic artery, vein and pancreas was associated with pancreatic fistula after gastrectomy .…”

“…It was difficult to define the name of the vein from the splenic flexure because the vein sometimes accompanied the LCA and sometimes the AMCA. Therefore, the drainage vein from the splenic flexure running below the pancreas was defined as the SFV .…”

“…Therefore, the positional relationship between the destination of the IMV and the pancreas must be identified. The anatomy of the IMV has been evaluated by Arimoto et al [9]. However, the relationship between the artery, vein and pancreas has not been evaluated.…”

“…Lymphatic flow can be detected along with the drainage vein . Therefore, it is important to understand the branching pattern of the AMCA as well as the anatomy of the drainage vein from the splenic flexure (the splenic flexure vein, SFV) .…”

“…The anatomy of the IMV has been evaluated by Arimoto et al . . However, the relationship between the artery, vein and pancreas has not been evaluated.…”