A case of spontaneous splenorenal shunt associated with splenic artery aneurysm
Tóm tắt
A case of large spontaneous splenorenal (S-R) shunt accompanied with splenic artery aneurysm is reported in this paper. The large blood vessel, a shunt, anatomizing the splenic vein and left renal vein is macroscopically found during the autopsy of a 71-year-old male, accompanied with liver cirrhosis and splenomegaly. Though there are many reports demonstrating medical imaging, anatomical findings are relatively poor besides describing and illustrating the appearances of the S-R shunt, the splenic artery aneurysm and related branches of the splenic vein and left renal vein, the embryologic and pathogenetic origins of these anomalies are also discussed with the description of the relationship between the S-R shunt and the splenic artery aneurysm.
Tài liệu tham khảo
Chiba S, Suzuki T, Kasai T (1991) A tongue-like projection of the left lobe in human liver, accompanied with lienorenal venous shunt and intrahepatic arterial anastomosis. Okajimas Folia Anat Jpn 68:51–66
De Franchis R, Primignani M (2001) The natural history of portal hypertension in patients with cirrhosis. Clin Liver Dis 5:645–663
Edwards EA (1951) Functional anatomy of the porta-systemic communications. AMA Arch Intern Med 88:137–154
Elliott SP, Yeh B, Stoller ML (2004) Radiologic appreciation of a spontaneous splenorenal shunt. Urology 63:776–777
Gonzales EM, Garcia-Blanch G, Blanco JMS, Garcia IG, Ocana AG (1981) Treatment of splenic artery aneurysm after distal splenorenal shunt. A case report. Jpn J Surg 11:377–380
Hanna SS, Smith RB, Henderson JM, Millikan WJ Jr, Warren WD (1981) Reversal of hepatic encephalopathy after occlusion of total portosystemic shunts. Am J Surg 142:285–289
Hirota S, Matsumoto S, Tomita M, Sako M, Kono M (1999) Retrograde transvenous obliteration of gastric varices. Radiology 211:349–356
Iannello S, Libertini L, Martini R, Spina S, Busacca G, Ricciardi N, Andreozzi G, Belfiore Fv (1999) A large spontaneous splenorenal shunt in a patient with liver cirrhosis and uncomplicated portal hypertension. Dig Dis 17:248–255
Kanagawa H, Mima S, Kouyama H, Gotoh K, Uchida T, Okuda K (1996) Treatment of gastric fundal varices by balloon-occluded retrograde transvenous obliteration. J Gastroenterol Hepatol 11:51–58
Kimura W (2000) Surgical anatomy of the pancreas for limited resection. J Hepatobililary Pancreat Surg 7:473–479
Mori T (1952) A case of anomalous connection between renal and lineal veins (in Japanese). Acta Anat Nippon 27:100–102
Numata K, Tanaka K, Kiba T, Saito S, Shirato K, Kitamura T, Sekihara H (1998) Use of balloon-occluded retrograde transvenous obliteration with ethanolamine oleate for the treatment of hepatic encephalopathy in a cirrhotic patient with a large spontaneous splenorenal shunt. J Gastroenterol 33:424–427
Ohnishi K, Sato S, Saito M, Terabayashi H, Nakayama T, Saito M, Chin N, Iida S, Nomura F, Okuda K (1986) Clinical and portal hemodynamic features in cirrhotic patients having a large spontaneous splenorenal and/or gastrorenal shunt. Am J Gastroenterol 81:450–455
Rousselot LM, Moreno AH, Panke WF (1959) Studies on portal hypertension IV. The clinical and physiologic significance of self-established (nonsurgical) portal systemic venous shunts. Ann Surg 150:384–410
Stanley JC, Fry WJ (1974) Pathogenesis and clinical significance of splenic artery aneurysms. Surgery 76:898–909
Sugimori K, Morimoto M, Shirato K, Kokawa A, Naohiko T, Numata K, Saito T, Tanaka K (2005) Retrograde transvenous obliteration of gastric varices associated with large collateral veins or a large gastrorenal shunt. J Vasc Interv Radiol 16: 113–118
Ueda J, Takahashi S, Furukawa T, Araki Y (1995) Portal hypertension with intra- and extrasplenic arterial aneurysms and large venous varices. Cardiovasc Intervent Radiol 18:243–246
Wind P, Alves A, Chevallier JM, Gillot C, Sales JP, Sauvanet A, Cuenod CA, Vilgrain V, Cugnenc PH, Delmas V (1998) Anatomy of spontaneous splenorenal and gastrorenal venous anastomoses. Review of the literature. Surg Radiol Anat 20:129–134
Zamora CA, Sugimoto K, Tsurusaki M, Yamaguchi M, Izaki K, Taniguchi T, Iwama Y, Mimura F, Sugimura K (2004) Portosplenic blood flow separation in a patient with portosystemic encephalopathy and a spontaneous splenorenal shunt. J Vasc Interv Radiol 15:875–879