Ann Hepatobiliary Pancreat Surg.  2017 May;21(2):93-95. 10.14701/ahbps.2017.21.2.93.

Distal pancreatectomy with splenorenal shunt to preserve spleen in a cirrhotic patient

• Ettorre GM
• Levi Sandri GB
• Colasanti
• de Werra E
• Lepiane P

• KMID: 2379108
• DOI: http://doi.org/10.14701/ahbps.2017.21.2.93

Abstract

At pancreatic ductal adenocarcinoma is an aggressive malignancy with a high recurrence rate. Due to its high potentials of local invasion and distant metastasis, surgical resection is the only means for possible long-term survival. Surgical treatment comprises a distal pancreatectomy with or without splenectomy. Surgery has been conventionally contraindicated for patients with cirrhosis and portal vein hepato-biliary hypertension. Splenorenal shunt was first described by Warren and colleagues, to prevent death from bleeding esophageal varices in a patient with a patent portal vein hypertension. A 55-year-old Caucasian woman presented with an incidental pancreatic tumor. In our case, the shunt was necessary to complete the corrective oncological surgery for pancreatic ductal adenocarcinoma. The main difficulty was the presence of portal hypertension due to liver cirrhosis Child A; moreover, preservation of the spleen was mandatory in this patient. We successfully performed a distal pancreatectomy without splenectomy through the help of splenorenal shunt to preserve venous circulation.

Keyword

Pancreatectomy; Portal hypertension; Splenorenal shunt; Warren shunt; Cirrhosis

MeSH Terms

Adenocarcinoma
Child
Esophageal and Gastric Varices
Female
Fibrosis
Hemorrhage
Humans
Hypertension
Hypertension, Portal
Liver Cirrhosis
Middle Aged
Neoplasm Metastasis
Pancreatectomy*
Pancreatic Ducts
Portal Vein
Recurrence
Spleen*
Splenectomy
Splenorenal Shunt, Surgical*

Figure

• 

  Fig. 1 Magnetic resonance image showing a pancreatic mass (A) and intraoperative photograph showing a splenorenal shunt formation (B). SV, splenic vein; RV, renal vein.

• 

  Fig. 2 Computed tomography images showing the Warren Shunt (A and B: arrow) and fluid collection (B: asterisk).

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