Fig 5 - uploaded by Lars G Crabo
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-Appearance of normal gastrocolic trunk on dynamic bolus-enhanced CT scan (original magnification xl .5). Short horizontal gastrocolIc trunk (GCT), formed by anterior superior pancreaticoduodenal vein (ASPDV), right superior colic vein (RCV), and right gastroepiploic vein (RGEV) anterior to uncinate process of pancreas, drains into superior mesentenic vein (SMV). P = head of pancreas, D = duodenum.
Source publication
This study was conducted to define the normal CT appearance of the four pancreaticoduodenal veins (anterior and posterior superior, and anterior and posterior inferior) in the head of the pancreas in injected cadaveric specimens and to assess the frequency with which these normal vessels are seen on dynamic contrast-enhanced CT scans.
The appearanc...
Citations
... Existing reports have mostly discussed branch morphologies and frequency of occurrence of the various systems of the superior mesenteric arteries and veins [7][8][9][10][11][12][13][14][15][16][17][18][19][20]. However, there are very few reports examining the correlations between the arteries and veins, with reports being limited to those discussing the relationship between the ileocolic artery (ICA) and vein with the superior mesenteric vein [21][22][23][24][25][26]. ...
Objectives: Few studies have examined the correlations between the arteries and veins of the right colon. In this study, we aimed to use high-resolution CT scans to understand the vascular anatomy of Henle's gastrocolic trunk and review the terminology describing the arteries and veins of the right colon.
Methods: This retrospective study has examined patients who underwent laparoscopic colectomy for right colon cancer in a single institution in Japan. Scans from consecutive patients who underwent surgery between October 2017 and March 2020 (n = 165) were examined. Preoperative CT images were used to create multiplanar reformation images and volume rendering images.
Results: Among the 139 patients with Henle's gastrocolic trunk (GCT) present, arteries accompanying the accessory right colic vein (ARCV) were most common on the right branch of the middle colic artery (MCA) (71.2%), followed by the right colic artery (RCA) (19.4%); meanwhile, 9.4% of the patients had no accompanying arteries. Of patients with no accompanying arteries to the ARCV, RCA was present in 15.4%. Among the 26 patients with no GCT, the right colic vein (RCV) existed in 15 patients, with the artery accompanying the RCV most commonly being the right branch of the MCA (66.6%), followed by the RCA (33.3%).
Conclusions: Irrespective of the presence of GCT, approximately 70% of the arteries accompanying the drainage vein from the right colon were the right branch of the MCA. We suggest that vascular branch formation be considered preoperatively in surgical management for right colon cancer.
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... Venous drainage of the body and tail of the pancreas is more variable but the common pattern is multiple small branches draining into the splenic vein. 8,11 ...
Recent advances in the surgical techniques and postoperative intensive care have led to a decrease in the mortality rates after major pancreatic procedures, which now ranges from 1 to 3%. However, the morbidity rates are still high, resulting in longer hospital stays and greater cost. Imaging plays a fundamental role in the postoperative assessment. Specially, multidetector computed tomography scans (MDCT) is the modality of choice in the postoperative settings. Early diagnosis of the postoperative complications and differentiating them from being normal or expected postoperative findings is crucial to offer the best possible care for patients and to decrease the morbidity and mortality associated with surgery. In this article, we will briefly review the normal pancreatic anatomy, discuss the main types of pancreatic surgeries, and illustrate the imaging findings during the early postoperative period and of the main postsurgical complications in both acute and chronic postoperative settings.
... contrast medium in the vessels, by the scan type (helical or conventional CT) and by the scan collimation. Moreover, although ASPDV is not found in some radiological studies because of the limited length of this vein [22,29,35], the frequency of CT visualization of GCT (86%) is comparable to that obtained in other cases (90% [29], 89% [4], 81% [25]). The intraoperative method involves a limited operative field of view, lack of tactile sensory input and difficulties in identifying the course of some tributaries compared with postmortem anatomic studies [14]. ...
Purpose
Venous vascular anatomy of the right colon presents a high degree of variability. Henle's Gastrocolic Trunk is considered an important anatomical landmark by colorectal surgeons. The classical description concerns a bipod vascular structure or tripod, but several variants are associated to it.
The aim of this study is to merge the most updated literature on the anatomy knowledge of the Gastrocolic Trunk by evaluating all possible variants, as well as to underline its surgical importance due to its topographical relationships.
Methods
Twelve studies describing the anatomy of the gastrocolic trunk were selected, each of them dealing with a more or less extensive series of cases. A distinction was drawn between the gastropancreatic trunk, devoid of the colonic component, and the gastrocolic trunk; and then the frequency of the different resulting variants was reported. The data obtained from cadavers and radiological studies were analyzed separately.
Results
The Gastrocolic Trunk is found in 74% of cadaver studies, and in 86% of radiological studies. Its most frequent configuration is represented by the union of right gastroepiploic vein + anterior superior pancreaticoduodenal vein + superior right colic vein, respectively, 32.5% and 42.5%, followed by the right colic vein which replaces (26.9%, 12.3%) or is added (10%, 20.1%) to the superior right colic vein.
Conclusions
The superior right colic vein joins the right gastroepiploic vein and the anterior superior pancreaticoduodenal vein thus forming, in most cases, the gastrocolic trunk. The anatomical knowledge of vascular structures forms the basis for both the interpretation of preoperative radiological images and the surgical procedure itself, despite the considerable anatomical variability of tributaries.
... The characteristics of the included studies are presented in Table 1. Overall, data concerning n=2,686 subjects were included in the meta-analysis (Descomps and De Lalaubie, 1912;Falconer and Griffiths, 1950;Couppié, 1957;Gillot et al., 1962;Chambon et al., 1979;Birtwisle et al., 1983;Mori et al., 1992;Crabo et al., 1993;Zhang et al., 1994;Hommeyer et al., 1995;Ibukuro et al., 1996;Graf et al., 1997;O'Malley et al., 1999;Ito et al., 2000;Lange et al., 2000;Yamada et al., 2000;Ignjatovic et al., 2004, 2008Matsuki et al., 2006;Sakaguchi et al., 2010;Walser et al., 2011;Khan et al., 2012;Li et al., 2013;Acar et al., 2014;Ogino et al., 2014;Chi et al., 2014;Cao et al., 2015;Hu et al., 2016;Lee et al., 2016;Stelzner et al., 2016;Alsabilah et al., 2017b;Kuzu et al., 2017). The included studies were published between 1912 and 2016, and the cohorts were investigated on three different continents: Asia (18 studies, n=1,489 subjects) Ibukuro et al., 1996;Yamada et al., 2000;Yamaguchi et al., 2002;Matsuki et al., 2006;Jin et al., 2006Jin et al., , 2008Sakaguchi et al., 2010;Li et al., 2013;Acar et al., 2014;Ogino et al., 2014;Chi et al., 2014;Cao et al., 2015;Hu et al., 2016;Lee et al., 2016;Alsabilah et al., 2017b;Kuzu et al., 2017), Europe (12 studies, n=789) (Descomps and De Lalaubie, 1912;Falconer and Griffiths, 1950;Couppié, 1957;Gillot et al., 1962;Chambon et al., 1979;Birtwisle et al., 1983;Zhang et al., 1994;Lange et al., 2000;Ignjatovic et al., 2004Ignjatovic et al., , 2010Khan et al., 2012;Stelzner et al., 2016), and North America (eight studies, n=438) (Mori et al., 1992;Crabo et al., 1993;Hommeyer et al., 1995;Graf et al., 1997;O'Malley et al., 1999;Ito et al., 2000;Walser et al., 2011). ...
... Overall, data concerning n=2,686 subjects were included in the meta-analysis (Descomps and De Lalaubie, 1912;Falconer and Griffiths, 1950;Couppié, 1957;Gillot et al., 1962;Chambon et al., 1979;Birtwisle et al., 1983;Mori et al., 1992;Crabo et al., 1993;Zhang et al., 1994;Hommeyer et al., 1995;Ibukuro et al., 1996;Graf et al., 1997;O'Malley et al., 1999;Ito et al., 2000;Lange et al., 2000;Yamada et al., 2000;Ignjatovic et al., 2004, 2008Matsuki et al., 2006;Sakaguchi et al., 2010;Walser et al., 2011;Khan et al., 2012;Li et al., 2013;Acar et al., 2014;Ogino et al., 2014;Chi et al., 2014;Cao et al., 2015;Hu et al., 2016;Lee et al., 2016;Stelzner et al., 2016;Alsabilah et al., 2017b;Kuzu et al., 2017). The included studies were published between 1912 and 2016, and the cohorts were investigated on three different continents: Asia (18 studies, n=1,489 subjects) Ibukuro et al., 1996;Yamada et al., 2000;Yamaguchi et al., 2002;Matsuki et al., 2006;Jin et al., 2006Jin et al., , 2008Sakaguchi et al., 2010;Li et al., 2013;Acar et al., 2014;Ogino et al., 2014;Chi et al., 2014;Cao et al., 2015;Hu et al., 2016;Lee et al., 2016;Alsabilah et al., 2017b;Kuzu et al., 2017), Europe (12 studies, n=789) (Descomps and De Lalaubie, 1912;Falconer and Griffiths, 1950;Couppié, 1957;Gillot et al., 1962;Chambon et al., 1979;Birtwisle et al., 1983;Zhang et al., 1994;Lange et al., 2000;Ignjatovic et al., 2004Ignjatovic et al., , 2010Khan et al., 2012;Stelzner et al., 2016), and North America (eight studies, n=438) (Mori et al., 1992;Crabo et al., 1993;Hommeyer et al., 1995;Graf et al., 1997;O'Malley et al., 1999;Ito et al., 2000;Walser et al., 2011). There were 21 imaging studies (n=1,589) (Mori et al., 1992;Crabo et al., 1993;Zhang et al., 1994;Hommeyer et al., 1995;Ibukuro et al., 1996;Graf et al., 1997;O'Malley et al., 1999;Yamada et al., 2000;Ito et al., 2000;Matsuki et al., 2006;Jin et al., 2008;Sakaguchi et al., 2010;Walser et al., This article is protected by copyright. ...
... The included studies were published between 1912 and 2016, and the cohorts were investigated on three different continents: Asia (18 studies, n=1,489 subjects) Ibukuro et al., 1996;Yamada et al., 2000;Yamaguchi et al., 2002;Matsuki et al., 2006;Jin et al., 2006Jin et al., , 2008Sakaguchi et al., 2010;Li et al., 2013;Acar et al., 2014;Ogino et al., 2014;Chi et al., 2014;Cao et al., 2015;Hu et al., 2016;Lee et al., 2016;Alsabilah et al., 2017b;Kuzu et al., 2017), Europe (12 studies, n=789) (Descomps and De Lalaubie, 1912;Falconer and Griffiths, 1950;Couppié, 1957;Gillot et al., 1962;Chambon et al., 1979;Birtwisle et al., 1983;Zhang et al., 1994;Lange et al., 2000;Ignjatovic et al., 2004Ignjatovic et al., , 2010Khan et al., 2012;Stelzner et al., 2016), and North America (eight studies, n=438) (Mori et al., 1992;Crabo et al., 1993;Hommeyer et al., 1995;Graf et al., 1997;O'Malley et al., 1999;Ito et al., 2000;Walser et al., 2011). There were 21 imaging studies (n=1,589) (Mori et al., 1992;Crabo et al., 1993;Zhang et al., 1994;Hommeyer et al., 1995;Ibukuro et al., 1996;Graf et al., 1997;O'Malley et al., 1999;Yamada et al., 2000;Ito et al., 2000;Matsuki et al., 2006;Jin et al., 2008;Sakaguchi et al., 2010;Walser et al., This article is protected by copyright. All rights reserved. ...
Introduction: Surgeons have recognized the clinical significance of the venous trunk of Henle during multiple pancreatic, colorectal, and hepatobiliary procedures. To date, no study has followed the principles of evidence‐based anatomy to characterize it. Our aim was to find, gather, and systematize available anatomical data concerning this structure.
Materials and Methods: The MEDLINE/PubMed, ScienceDirect, EMBASE, BIOSIS, SciELO, and Web of Science databases were searched. The following data were extracted: prevalence of the trunk of Henle, its mean diameter and length, the organization of its tributaries, method of anatomical assessment (cadaveric, radiological, or intraoperative), geographical origin, study sample, and known health status.
Results: Our search identified 38 records that included data from 2,686 subjects. Overall, the prevalence of the trunk of Henle was 86.9% (95% CI: 0.81–0.92) and the mean diameter was 4.2 mm. Only one study reported the length of the trunk (10.7 mm). The most common type of venous trunk (56.1%) was a vessel comprising three tributaries: gastric (right gastro‐epiploic vein), pancreatic (most commonly the anterior superior pancreaticoduodenal vein), and colic (most commonly the superior right colic vein).
Conclusions: The trunk of Henle is a common variant in the anatomy of the portal circulation. It is a highly variable vessel, but the most common type is a gastro‐pancreato‐colic trunk. In surgical practice, the presence of this venous trunk poses a high risk for bleeding, but it can also be a useful landmark during various abdominal procedures.
... The studies were published between 1909-2017, with a sample size ranging from 9 to 610 specimens. The superior mesenteric vessels and their branches were investigated by dissections of cadaveric specimens in 21 studies 15,16,[22][23][24][25][26][27]29,38,39,44,45,49,52,[54][55][56][57][58][59] , by imaging methods in 16 studies (CT − 13 studies 18,21,28,[32][33][34][35]37,40,43,50,51,53 , MRI -one study 41 , CT and surgeryone study 20 , Angiography -one study 46 ), and by dissection during surgical procedures in eight studies (surgical dissection only -six studies 17,30,31,36,47,48 , surgical dissection and angiography -one study 42 , surgical and cadaveric dissection -one study 19 ). ...
The surgeon dissecting the base of the mesenterium, around the superior mesenteric vein (SMV) and artery, is facing a complex tridimensional vascular anatomy and should be aware of the anatomical variants in this area. The aim of this systematic review is to propose a standardized terminology of the superior mesenteric vessels, with impact in colon and pancreatic resections. We conducted a systematic search in PubMed/MEDLINE and Google Scholar databases up to March 2017. Forty-five studies, involving a total of 6090 specimens were included in the present meta-analysis. The pooled prevalence of the ileocolic, right colic and middle colic arteries was 99.8%, 60.1%, and 94.6%, respectively. The superior right colic vein and Henle trunk were present in 73.9%, and 89.7% of specimens, respectively. In conclusion, the infra-pancreatic anatomy of the superior mesenteric vessels is widely variable. We propose the term Henle trunk to be used for any venous confluence between gastric, pancreatic and colic veins, which drains between the inferior border of the pancreas and up to 20 mm downward on the right-anterior aspect of the SMV. The term gastrocolic trunk should not be synonymous, but a subgroup of the Henle trunk, together with to gastropancreatocolic, gastropancreatic, or colopancreatic trunk.
... The studies were published between 1890 and 2017, with a sample size ranging from 18 to 2170 specimens. The superior mesenteric vessels and their branches were investigated by radiologic methods in 38 studies (CT-28 studies, 3,[19][20][21]37,41,43,[45][46][47][48][49][50][51][52][53][54]56,61,62,[67][68][69][70]72,73,75,76 MRI-1 study, 58 angiography-9 studies, 22,23,26,60,63,[78][79][80][81] by dissection during surgical procedures in 7 studies, 24,40,42,44,71,74,93 and by dissections of cadaveric specimens in 34 studies. 25,[27][28][29][30][31][32][33][34][35][36]38,39,55,57,59,64,65,67,78,[83][84][85][86][87][88][89][90][91][92][93]95,96 Quality Assessment of the Included Studies ...
... P < 0.001). 25,28,42,52,56,58,72,75 The mean diameter of the ASPDV was 1.70 mm (95% CI 1.20 to 2.21, P < 0.001, I 2 = 94.29, P < 0.001). ...
... P < 0.001). 56,72,75 The ASPDV drainage was into gastrocolic trunk of Henle (GTH) in 83.2% ...
Background and Purpose:
Mesopancreas dissection with central vascular ligation and the superior mesenteric artery (SMA)-first approach represent the cornerstone of current principles for radical resection for pancreatic head cancer. The surgeon dissecting around the SMV and SMA should be aware regarding the anatomical variants in this area. The aims of this systematic review and meta-analysis are to detail the surgical anatomy of the superior mesenteric vessels and to propose a standardized terminology with impact in pancreatic cancer surgery.
Methods:
We conducted a systematic search to identify all published studies in PubMed/MEDLINE and Google Scholar databases from their inception up to March 2017.
Results:
Seventy-eight studies, involving a total of 18,369 specimens, were included. The prevalence of the mesenteric-celiac trunk, replaced/accessory right hepatic artery (RRHA), common hepatic artery, and SMV inversion was 2.8, 13.2, 2.6, and 4.1%, respectively. The inferior pancreaticoduodenal artery has its origin into the first jejunal artery, SMA, and RRHA, in 58.7, 35.8, and 1.2% of cases, respectively. The SMV lacks a common trunk in 7.5% of cases. The first jejunal vein has a trajectory posterior to the SMA in 71.8% of cases. The left gastric vein drains into the portal vein in 58%, in splenic vein (SV) in 35.6%, and into the SV-PV confluence in 5.8% of cases.
Conclusions:
Complex pancreaticoduodenal resections require detailed knowledge of the superior mesenteric artery and vein, which is significantly different from the one presented in the classical textbooks of surgery. We are proposing the concept of the first jejunopancreatic vein which impacts the current oncological principles of pancreatic head cancer resection.
... As a result, the quality of CT images of portal venous system collaterals became almost equivalent to that obtained by DSA. The achieved progress was originally used in evaluation of venous infiltration by neoplasms [5][6][7] . No other imaging techniques including MR were considered of greater accuracy in that matter, except for intraportal endovascular ultrasonography which proved to have advantage over CT and even angiography. ...
... The right sided paracholedochal plexus can communicate with the gastrocolic trunk and pancreaticoduodenal vein and drain into the cystic duct or directly into the liver while the left-sided plexus can communicate with the first jejunal trunk, left and right gastric veins and the left portal vein. 11,12 The venous drainage of the bile duct is depicted in Figure 1. ...
The pathogenesis of portal cavernoma cholangiopathy (PCC) is important as it can impact the choice of treatment modalities. PCC consists of a reversible component, which resolves by decompression of collaterals as well as a fixed component, which persists despite the decompression of collaterals. The reversible component is due to compression by large collaterals located adjacent to the bile duct as well as possibly intracholedochal varices. The fixed component is likely to be due to ischemia at the time of portal vein thrombosis, local ischemia by compression as well as encasement by a solid tumor-like cavernoma comprising of fibrous hilar mass containing multiple tiny collateral veins rather than markedly enlarged portal collaterals. Although cholangiographic abnormalities in portal hypertension are common, the prevalence of symptomatic PCC is low. This is likely to be related to the cause of portal hypertension, the duration of portal hypertension and possibly the pattern of occlusion of the splenoportal axis. There may possibly be higher prevalence of symptomatic PCC in extension of the thrombosis to the splenomesentric veins.
... First jejunal vein is identified as the only vein coursing posterior to the superior mesenteric artery before its termination into superior mesenteric vein. In a smaller percentage the first jejunal vein can traverse anterior to the superior mesenteric artery (Fig. 5E, F) [31][32][33] ...
... Anterior superior pancreaticoduodenal vein passes between the inferior surface of the pancreatic head and the third portion of the duodenum to drain into gastrocolic trunk. [31][32][33] Posterior superior pancreaticoduodenal vein is formed medial to the mid point of descending duodenum, runs supero-medially on the posterior surface of head of pancreas, posterior to common bile duct and drains into portal vein behind the neck of pancreas at around the upper border of pancreas. 34,35 The body of the pancreas is drained by numerous short pancreatic tributaries, which join the anterior surface of splenic vein. ...
... Computed tomography scans with contrast and magnetic resonance angiography have demonstrated the tributaries of portal venous system in detail. [20][21][22][23]26,28,29,31,32,[45][46][47] Computed tomography scan despite being an ideal modality does not render tools for assessing hemodynamics of the portal vessels. The magnetic resonance angiography gives excellent 3-dimensional images but shows overlapping of the arterial vessels on the portal venous system and its branches. ...
Linear Endosonography has been used to image the Portal Venous System but no established standard guidelines exist. This article presents techniques to visualize the portal venous system and its tributaries by linear endosonography. Attempt has been made to show most of the first order tributaries and some second order tributaries of splenic vein, superior mesenteric vein and portal vein.
... First jejunal vein is identified as the only vein coursing posterior to the superior mesenteric artery before its termination into superior mesenteric vein. In a smaller percentage the first jejunal vein can traverse anterior to the superior mesenteric artery (Fig. 5E, F) [31][32][33] ...
... Anterior superior pancreaticoduodenal vein passes between the inferior surface of the pancreatic head and the third portion of the duodenum to drain into gastrocolic trunk. [31][32][33] Posterior superior pancreaticoduodenal vein is formed medial to the mid point of descending duodenum, runs supero-medially on the posterior surface of head of pancreas, posterior to common bile duct and drains into portal vein behind the neck of pancreas at around the upper border of pancreas. 34,35 The body of the pancreas is drained by numerous short pancreatic tributaries, which join the anterior surface of splenic vein. ...
... Computed tomography scans with contrast and magnetic resonance angiography have demonstrated the tributaries of portal venous system in detail. [20][21][22][23]26,28,29,31,32,[45][46][47] Computed tomography scan despite being an ideal modality does not render tools for assessing hemodynamics of the portal vessels. The magnetic resonance angiography gives excellent 3-dimensional images but shows overlapping of the arterial vessels on the portal venous system and its branches. ...
