Superior mesenteric vein

Blood is supplied to the jejunum and ileum via the superior mesenteric artery arising from the aorta. Venous blood returns to the superior mesenteric vein, which combines with the splenic vein to form the portal vein. Thus drugs absorbed through these parts pass initially through the liver. 

Li, K. C., R.L. Dalman, I.Y. Chen, L.R. Pelc, C.K. Song, W.K. Moon, M.I. Kang, and G.A. Wright (1997). Chronic mesenteric ischemia use of in vivo MR imaging measurements of blood oxygen saturation in the superior mesenteric vein for diagnosis. Radiology 204 71-77. 

Restricted respiratory modulation of the vascular width of up to 3 mm (increase on inspiration and decrease on exspiration) regarding the portal vein and more particularly the splenic vein and the superior mesenteric vein. Decrease in width of the lumen by more than 50% on exhalation = absence of portal hypertension... 

Indirect splenoportography via the femoral artery is not only very important, but also low-risk. (s. p. 182) Using radiography, the arterial branches of the abdominal aorta initially become visible, followed by the spleen, the splenic vein and the portal vein together with its afferent veins and collaterals. This procedure provides information on (7.) localization of vascular resistance-related hypertension, (2.) cause of portal hypertension (in individual cases), (3.) patency and diameter of the respective vessel, 4.) extent of collateral circulation, (5.) hepatopetal or hepatofugal direction of flow in the portal vein, and 6.) shunt capacity of the splenic vein or superior mesenteric vein. (s. p. 182)... 

Varices occasionally occur in the stomach (122), duodenum (59,148), small intestine, gall bladder (84) and colon (18, 45, 48, 63, 146) - excluding the transverse colon - as well as in the proximity of operative anastomoses or stomata. This generally involves collaterals between the branches of the inferior or superior mesenteric vein and small veins leading to the inferior vena cava. Colonic varices, which have not been detected endoscopically can be demonstrated by visceral angiography with a sensitivity of about 95%. 

Portal vein plus superior mesenteric vein thromboses... 

Portal vein thrombosis (with open superior mesenteric vein)... 

Previous shunt operations and TIPS need to be removed in order to guarantee that the transplanted liver is sufficiently supplied with portovenous blood. In these cases, the portal system is checked preoperatively for thromboses by means of colour-encoded duplex sonography and X-ray techniques. In any case, the confluence of superior mesenteric vein and splenic vein must be free. (391) The main advantage of portacaval end-to-side anastomosis is its low thrombosis rate of < 5% in addition, there is no need for a distal shunt ligature. In shunts distal to the hilus (mesocaval, distal splenorenal), no preparation of the liver hilus is required however, in 10% of cases, these shunts show portal vein thrombosis (in TIPS, up to 15%). Usually, all surgical shunts are disconnected or ligated before the liver transplantation is completed in order to... 

The portal circulation handles aU of the venous outflow of the GI tract, the spleen, the pancreas, and the gallbladder (Figure 47-11). The portal vein is formed by the union of the splenic vein and the superior mesenteric vein. Portal flow is normally 1000 to 1200mL/min with a pressure of 5 to 7 mm... 

SV( splenic vein SAIVI superior mesenteric vein. (From Zakim 0, Boyer TD. Hepatology A textbook of liver disease, 3rd ed. Philadelphia VYB Saunders, 1996 721.)... 

The characteristic finding of midgut volvulus in the US examination is the whirlpool sign produced by the twisting of the bowel, mesentery, and superior mesenteric vein around the axis of the superior mesenteric artery (Fig. 1.13). The whirlpool sign, proposed by Pracros et al. (1992), directly indicates the anatomic alteration caused by midgut volvulus. The SM V and tributaries wrap around the SMA as a result of the volvulus, resulting in a partial or com-... 

The duodenum is typically divided into four portions. The first portion is relatively mobile in contrast to the rest of the duodenum which is fixed in the retroperitoneal cavity. The second descending portion of the duodenum is in close contact with the pancreas and receives the common bile duct and duct of Wirsung in its midportion. The third portion is horizontally oriented and is ventrally crossed by the superior mesenteric artery (SMA) and superior mesenteric vein (SMV). The fourth ascending portion will turn ventrally to the duodenojejunal junction, which is additionally held in place by the ligament of Treitz. 

The width of the antral area is measured in a vertical section in which the antrum, the superior mesenteric vein and the aorta are visualized simultaneously. The outer profile of the muscularis propria is outlined and the area calculated automatically (Fig. 22.1). The values obtained of all measurements are given as the average of two successive measurements. 

Fig. 20.12a,b. Portal vein pathologies, a MIP image reconstruction from a CT dataset shows complete thrombosis of the portal vein and of its right branch, and partial thrombosis of the superior mesenteric vein, b MIP image reconstruction from a MR dataset shows a portal cavernoma... 

Invasion into peripancreatic veins portal vein, superior mesenteric vein (relative contraindication, T3)... 

For the superior mesenteric vein and the portal vein, the teardrop sign has been described, which is also a strong indicator for tumor vessel infiltration (Fig. 30.5). It means that a teardrop-like deformity of the su-... 

Hough TJ, Raptopoulos V, Siewert B, Matthews JB (1999) Teardrop superior mesenteric vein CT sign for unresec-table carcinoma of the pancreas. AJR Am J Roentgenol 173 1509-1512... 

Fig.7.8a,b. Pyogenic abscess, a Pyogenic abscess in a 35-year old man status post laparoscopic right hepatectomy due to an hydatid cyst. Portal venous-phase contrast-enhanced CT scan shows a thick-walled cystic lesion with homogeneous low attenuation. b Pyogenic abscess with presence of gas within the lesion in a 52-year-old man with fever, head of pancreas neoplasia (not resectable due to superior mesenteric vein infiltration) and recent portal thrombosis. An axial portal phase CT scan shows an hypoattenuating lesion with non-homogeneous content and gas inside... 

Fig. 7.14a,b. A 43-year-old woman with abdominal discomfort image obtained 12 days after simultaneous pancreas-kidney transplantation, a, b Contrast-enhanced multidetector CT displays acute thrombosis of superior mesenteric vein (arrowheads) and splenic vein (arrowhead) but homogeneous contrast enhancement of pancreatic graft (arrow) with donor s duodenum (arrows) and renal graft (asterisk). (CIA common iliac artery, CIV common iliac vein, d donor s, IPDA inferior pancreaticoduodenal artery, / left, r right, SA splenic artery, SMA superior mesenteric artery)... 

Fig. 7.22. Image from a 34-year-old woman obtained 5 months after simultaneous pancreas-kidney transplantation with exudative pancreatitis and pseudocyst formation. Contrast-enhanced helical CT displays homogeneous enhancement of small pancreatic graft (arrow) surrounded by thin-walled peripancreatic pseudocyst (arrowhead) and various intra-abdominal pseudocysts (white asterisk). Annotations renal graft (black asterisk). (CIA Common iliac artery, d donor s, SMA superior mesenteric artery, SMV superior mesenteric vein)...

Fig. 7.30a-c. Schematic illustrations of isolated intestinal transplantation. (Ao abdominal aorta, CIA common iliac artery, d donor, IVC inferior vena cava, L liver, r recipient, S spleen, ST stomach, SMA superior mesenteric artery, SMV superior mesenteric vein, TI temporary ileostomy.) Annotation duodenojejunal anastomosis (arrow), ileocolonic anastomosis (arrows), superior mesenteric vein stump (open arrowhead), venous extension graft (closed arrowhead), intestinal graft (black asterisk), residual recipient colon (white asterisk), a Depiction of intestinal graft after explantation and ex situ preparation on back-table, b Depiction of intraoperative appearance of recipient site after heterotopic intestinal transplantation shows end-to-side anastomosis of recipient common iliac artery to donor superior mesenteric artery and donor superior mesenteric vein to recipient inferior vena cava, c Depiction of intraoperative appearance of recipient site after orthotopic intestinal transplantation shows end-to-side anastomosis of recipient infrarenal abdominal aorta to donor superior mesenteric artery and donor superior mesenteric vein to recipient superior mesenteric vein stump utilizing venous extension graft... 

Fig. 7.33a,b. Contrast-enhanced MDCT obtained 4 months after operation in 5-year-old girl with short-bowel syndrome after intestinal transplantation. (Ao abdominal aorta, C colon, CIA common iliac artery, d donor, D duodenum, I ileum, IMA inferior mesenteric artery, IVC inferior vena cava, / jejunum, r recipient, SMV superior mesenteric vein.) Annotations intestinal graft lumen white asterisk), subsegmental arteries and veins in mesenteric fat of intestinal graft arrow), donor lymph node black arrowhead), proximal intestinal anastomosis between white arrowheads), distal intestinal anastomosis between white arrows). a, b Images show (a) proximal intestinal end-to-end anastomosis between white arrowheads) between recipient duodenum and donor jejunum as well as (b) distal intestinal end-to-end anastomosis between white arrows) marked by hyperdense staple line between donor ileum and recipient ascending colon... 

---