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Collateral Venous Pathways in the Transverse Mesocolon and Greater Omentum in Patients with Pancreatic Disease

¹ All authors: Department of Radiology, Mitsui Memorial Hospital, 1-Kanda Izumicho, Chiyoda-ku, Tokyo 101-8643, Japan.

View larger version (174K): [in a new window]   Fig. 1A. —78-year-old woman with pancreas body carcinoma. Selective splenic artery digital subtraction angiography (venous phase) shows that splenic venous flow runs through distal portion of splenic vein, inferior mesenteric vein (arrowheads), left transverse colic vein (large black arrow), marginal vein (small black arrows) extending along transverse colon, and middle colic vein (M), then ends at superior mesenteric vein (star). Note gastroepiploic vein (white arrows) is also shown and mimics marginal vein along transverse colon.

View larger version (113K): [in a new window]   Fig. 1B. —78-year-old woman with pancreas body carcinoma. Contrast-enhanced axial CT scan shows low-density mass (long arrow) where splenic vein (arrowhead) is occluded. Note dilated gastroepiploic vein (short arrows) along great curvature of stomach.

View larger version (110K): [in a new window]   Fig. 1C. —78-year-old woman with pancreas body carcinoma. Contrast-enhanced axial CT scan shows dilated middle colic vein (thin arrow) ending at anterior aspect of superior mesenteric vein. Note dilated inferior mesenteric vein (arrowhead) and left transverse colic vein (thick arrow).

View larger version (26K): [in a new window]   Fig. 1D. —78-year-old woman with pancreas body carcinoma. Drawing shows left-to-right direction of blood flow. When proximal splenic vein is obstructed, splenic venous flow runs into inferior mesenteric vein, left transverse colic vein, marginal vein along transverse colon, then middle colic vein (M), ending at superior mesenteric vein. X indicates location of venous obstruction and arrows indicate direction of blood flow. RGV = right gastric vein, LGV = left gastric vein, SGV = short gastric vein, IMV = inferior mesenteric vein, GEV = gastroepiploic vein, EV = epiploic vein, MV = marginal vein along transverse colon, GCT = gastrocolic trunk, LTCV = left transverse colic vein, SP = spleen, ST = stomach.

View larger version (162K): [in a new window]   Fig. 2A. —57-year-old woman with postoperative change to pancreatic head. Selective superior mesenteric artery angiography (venous phase) shows venous flow of superior mesenteric vein empties into middle colic vein (star), left transverse colic vein (arrowheads), inferior mesenteric vein, and splenic vein (arrow), then flows toward portal vein.

View larger version (24K): [in a new window]   Fig. 2B. —57-year-old woman with postoperative change to pancreatic head. Drawing shows right-to-left direction of blood flow. Because confluence of superior mesenteric vein with portal vein is obstructed, blood flow of superior mesenteric vein runs into middle colic vein (M), marginal vein along transverse colon, left transverse colic vein, inferior mesenteric vein, then splenic vein. X indicates location of venous obstruction and arrows indicate direction of blood flow. IMV = inferior mesenteric vein, LTCV = left transverse colic vein, MV = marginal vein along transverse colon.

View larger version (149K): [in a new window]   Fig. 3A. —48-year-old woman with giant pancreatic cyst. Celiac artery digital subtraction angiography (venous phase) shows arch of dilated epiploic vein (arrowheads) running from splenic hilum toward pelvis, then right and upward. C = giant pancreatic cyst.

View larger version (24K): [in a new window]   Fig. 3B. —48-year-old woman with giant pancreatic cyst. Drawing shows direction of blood flow in omental vein. When splenic vein is occluded, splenic venous flow can empty into epiploic branch of left gastroepiploic vein. Because anastomosis exists between left and right epiploic veins, which makes a venous arch, splenic venous blood flow runs into gastrocolic trunk, then portal vein. X indicates location of venous obstruction and arrows indicate direction of blood flow. GCT = gastrocolic trunk, GEV = gastroepiploic vein, EV = epiploic vein, SP = spleen.

View larger version (170K): [in a new window]   Fig. 4A. —Dissected abdomen from cadaver of 67-year-old woman with no evidence of abdominal disease. Photograph shows anterior aspect of stomach and greater omentum. Anastomosis of right and left epiploic veins in greater omentum, arch of epiploic vein (arrowheads), is located inferior to gastroepiploic vein (arrows) extending along greater curvature of stomach. ST = stomach, OM = greater omentum.

View larger version (162K): [in a new window]   Fig. 4B. —Dissected abdomen from cadaver of 67-year-old woman with no evidence of abdominal disease. Photograph shows posterior aspect of transverse mesocolon and left mesocolon. Small intestine was removed. Transverse colon (TC) was flipped upward to show transverse mesocolon. Two venous branches extend from inferior mesenteric vein toward marginal vein (arrows) along transverse colon, left transverse colic vein (black arrowheads), and left superior colic vein (white arrowheads). Note left transverse colic vein accompanying accessory middle colic artery. IMA = inferior mesenteric artery, IMV = inferior mesenteric vein, D = fourth portion of duodenum.

View larger version (18K): [in a new window]   Fig. 5. —Drawing of sagittal section of transverse mesocolon and greater omentum shows spatial relationship between splenic vein (SpV), short gastric vein (SGV), gastroepiploic vein (GEV), marginal vein along transverse colon (MV), and epiploic vein (EV). When splenic vein is occluded, four anatomically possible pathways exist that splenic venous flow drains: short gastric vein, gastroepiploic vein in gastrocolic ligament, epiploic vein in greater omentum, and marginal vein of transverse colon in transverse mesocolon. P = pancreas.

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