Table of Contents    
Case Report
 
Splenic vein turndown for vascular reconstruction following pancreatic cancer resection in patients with high risk profile
Emma Clout1, James Wei Tatt Toh1, Adeeb Majid1, Ju-En Tan1, Jim Iliopoulos1, Neil Merrett1
1Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia; University of Western Sydney, NSW, Australia.

Article ID: 100058IJHPDEC2016
doi:10.5348/ijhpd-2016-58-CR-14

Address correspondence to:
Emma Samantha Clout
C/- Bankstown-Lidcombe Hospital
Eldridge Rd, Bankstown, NSW
Australia 2200

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How to cite this article:
Clout E, Toh JWT, Majid A, Ju-En T, Iliopoulos J, Merrett N. Splenic vein turndown for vascular reconstruction following pancreatic cancer resection in patients with high risk profile. Int J Hepatobiliary Pancreat Dis 2016;6:76–80.


Abstract
Introduction: Vascular reconstruction is utilized following resections for pancreatic cancers with borderline resectability. This is defined by venous or partial superior mesenteric artery (SMA) involvement, where vessels are resected en bloc to achieve an R0 resection. There are many vascular reconstruction techniques post en bloc R0 resection, each with its own complication profile. The splenic turndown technique separates the vascular anastomosis from the pancreatic anastomosis, reducing the risk of vascular disruption should a pancreatic leak occur.
Case Report: This is the first report in literature of the splenic vein turndown technique being utilized for vascular reconstruction post- pancreatic resection for borderline resectable pancreatic cancer. To date, splenic vein turndown repair has only been described in a trauma setting. In this case, splenic vein turndown was preferred as the patient was on long-term corticosteroids with a high risk of anastomotic leak.
Conclusion: This case report showing that splenic vein turndown technique is a feasible option for vascular reconstruction post-pancreatic resection. The main disadvantage of this technique is high risk of segmental portal hypertension if the spleen is not removed concomitantly. For this reason, its utility should be restricted to patients at high risk of pancreatic leak.

Keywords: Pancreatic cancer, R0 resection, Splenic vein turndown technique, Venous reconstruction


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Author Contributions
Emma Clout – Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
James Wei Tatt Toh – Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Adeeb Majid – Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Ju-En Tan – Substantial contributions to conception and design, Acquisition of data, Drafting the article, Final approval of the version to be published
Jim Iliopoulos – Substantial contributions to conception and design, Acquisition of data, Revising the article critically for important intellectual content, Final approval of the version to be published
Neil Merrett – Substantial contributions to conception and design, Acquisition of data, Revising the article critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Emma Clout et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.