Portacaval anastomosis

Portacaval anastomosis
Portacaval anastomosis
Other names	Porto-systemic anastomosis Portal caval system

A portocaval anastomosis or porto-systemic anastomosis is a specific type of anastomosis that occurs between the veins of the portal circulation and those of the systemic circulation. When there is a blockage of the portal system, portocaval anastomosis enables the blood to still reach the systemic venous circulation. The inferior end of the esophagus and the superior part of the rectum are potential sites of a harmful portocaval anastomosis.[1]

In portal hypertension, as in the case of cirrhosis of the liver, the anastomoses become congested and form venous dilatations. Such dilatation can lead to esophageal varices and anorectal varices. Caput medusae can also result.[2]

Presentation

Clinical presentations of portal hypertension include:

Region	Name of clinical condition	Portal circulation	Systemic circulation
Esophageal	Esophageal varices	Esophageal branch of left gastric vein	Esophageal branches of azygos vein
Rectal	Rectal varices	Superior rectal vein	Middle rectal veins and inferior rectal veins
Paraumbilical	Caput medusae	Paraumbilical veins	Superior epigastric vein
Retroperitoneal	Splenorenal shunt[3]	Splenic vein	Renal vein, suprarenal vein, paravertebral vein, and gonadal vein
Retroperitoneal	(no clinical name)[4]	Right colic vein, middle colic vein, left colic vein	Retroperitoneal veins of Retzius
Intrahepatic	Hepatic pseudolesions[5]	Perihepatic veins of Sappey	Superior epigastric vein
Intrahepatic	Patent ductus venosus	Left branch of portal vein	Inferior vena cava

A dilated inferior mesenteric vein may or may not be related to portal hypertension. Other areas of anastomosis include the bare area of the liver as it connects to the diaphragm, the posterior portion of the gastrointestinal tract as it touches the posterior abdominal wall, the posterior surface of the pancreas, and the inferior part of the esophagus.

References

Sato, Takahiro; Akaike, Jun; Toyota, Jouji; Karino, Yoshiyasu; Ohmura, Takumi (2011). "Clinicopathological Features and Treatment of Ectopic Varices with Portal Hypertension". International Journal of Hepatology. 2011: 960720. doi:10.4061/2011/960720. PMC 3170857. PMID 21994879.
Gray's Anatomy for Students Gray H, Drake R, Vogl W, Mitchell A, Tibbitts R, Richardson P. Philadelphia: Elsevier/Churchill Livingstone; 2010. p. 226
D'Souza, Donna. "Portal-systemic collateral pathways | Radiology Reference Article | Radiopaedia.org". radiopaedia.org. Retrieved 2016-08-12.
"Surgicomania: Portal Hypertension". surgicomania.blogspot.co.uk. 2009-11-23. Retrieved 2016-08-12.
Khader.O.Thabet, Mohammed Al. "Hepatic pseudolesion near falciform ligament | Radiology Reference Article | Radiopaedia.org". radiopaedia.org. Retrieved 2016-08-12.

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[1] Sato, Takahiro; Akaike, Jun; Toyota, Jouji; Karino, Yoshiyasu; Ohmura, Takumi (2011). "Clinicopathological Features and Treatment of Ectopic Varices with Portal Hypertension". International Journal of Hepatology. 2011: 960720. doi:10.4061/2011/960720. PMC 3170857. PMID 21994879.

[2] Gray's Anatomy for Students Gray H, Drake R, Vogl W, Mitchell A, Tibbitts R, Richardson P. Philadelphia: Elsevier/Churchill Livingstone; 2010. p. 226

[3] D'Souza, Donna. "Portal-systemic collateral pathways | Radiology Reference Article | Radiopaedia.org". radiopaedia.org. Retrieved 2016-08-12.

[4] "Surgicomania: Portal Hypertension". surgicomania.blogspot.co.uk. 2009-11-23. Retrieved 2016-08-12.

[5] Khader.O.Thabet, Mohammed Al. "Hepatic pseudolesion near falciform ligament | Radiology Reference Article | Radiopaedia.org". radiopaedia.org. Retrieved 2016-08-12.