A report of a case: unusual portosystemic shunt in a hernia sac who has portal hypertension due to cirrhosis
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ANATOMIC VARIATIONS
A report of a case: unusual portosystemic shunt in a hernia sac who has portal hypertension due to cirrhosis Aykut Çelik1 · Abdullah Kut1 · Burak İlhan1 Received: 7 May 2020 / Accepted: 4 September 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Background Variations in the origin and branching pattern of splenic vein (SV) are relatively rare and asymptomatic. We describe here only the first case in the literature of accessory SV in hernia sac due to previous operation and increased portal pressure because of cirrhosis. Case presentation This report describes a 66-year-old female, with a history of total abdominal hysterectomy (TAH) due to uterine myomatosis, signs of cirrhosis onset due to hepatitis B, who had been presented with recurrent abdominal pain attacks. Ultrasonography (USG) findings were nothing pathologic except a gallstone in the gallbladder without cholecystitis signs. Incisional hernia was found to contain an accessory SV in the hernia sac arising from a branch of main SV in the hilum, ongoing to the subcutaneous fat tissue and draining to the superficial femoral vein on computed tomography (CT). Videoendoscopy showed wide gastritis and multiple ulcers. The patient’s symptoms diminished with proton pump inhibitor (PPI) treatment and they then underwent a hernia repair surgery with Prolene mesh patch as elective surgery. Conclusions A thorough knowledge of the normal anatomy, most frequent variations and congenital or acquired anomalies of the spleno-portal axis has great importance for hepatopancreaticobiliary and emergency surgical procedures. It is, therefore, essential for preoperative evaluation of the anatomical details of the spleno-portal venous axis and should be evaluated with imaging methods in detail. Keywords Accessory splenic vein · Portosystemic shunt · Hernia sac
Introduction
Case presentation
Normally, the splenic vein lies immediately posterior to the pancreas and follows a straight course (unlike the tortuous splenic artery) to the hilum of the spleen. The body and tail of the pancreas are seen anterior to the splenic vein. A thorough knowledge of the normal anatomy and frequent variations of the splenic vein is of great importance for surgeons who have a possibility to accidentally run into with SV during surgery. Variations can be explained with a defect in the development of omental bursa or with malrotation of the pancreatic body and tail. Unlike these predictable variations, this study presents an unprecedented variation in the literature.
A 66-year-old female with signs of cirrhosis onset and with a history of TAH with an open technique and midline incision due to uterine myomatosis (pathological examination resulted as benign) presented with recurrent abdominal pain attacks and with a large incisional hernia. She had no history of local wound complication after surgery and was not aware of incisional hernia until she had been prognosed because of abdominal pain. She has been admitted multiple times with complaints of d
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