SUPERIOR MESENTERIC VENOUS ANEURYSM

The case of a 50-year-old woman with an extremely rare venous malforma tion of the portal venous system is reported. The patient presented wi th a true aneurysm of the superior mesenteric vein, which has thus far been reported in no more than eight cases worldwide. this malformatio n may be congenital or acquired. Secondary aneurysms are thought to be due to liver disease, portal hypertension, trauma, or inflammation. A neurysms of the portomesenteric venous system may be asymptomatic or g ive rise to severe, often dramatic conditions such as crampy abdominal pain, jaundice, and upper gastrointestinal hemorrhage secondary to po rtal hypertension. The diagnosis is usually made by ultrasound (B-mode or color flow Doppler), CT scan, and MRI. Invasive procedures such as venous phase mesenteric arteriography or splenoportography may be hel pful in confirming it. in our opinion aneurysms of the portal venous s ystem, even if they are congenital and (still) asymptomatic, require e arly surgical control because the prognosis for patients with these an eurysms is unpredictable and potential complications (e.g., portal hyp ertension, fistula, contained perforation, or rupture) may be fatal. I n the case presented the mesenteric venous aneurysm was resected and t he confluent veins were reconstructed.