ANATOMY OF SPONTANEOUS SPLENORENAL AND GASTRORENAL VENOUS ANASTOMOSES- REVIEW OF THE LITERATURE

Portal hypertension is characterised by the development of a collatera l portocaval circulation. Among these venous reroutings, some are situ ated posteriorly in the left subphrenic compartment. These are the spo ntaneous splenorenal and gastrorenal anastomoses. Their incidence is e stimated at around 16%. On the one hand, there are the direct shunts, which anastomose the spelling v. to the left renal v., of an anecdotal nature, and on the other the spontaneous indirect splenorenal shunts, characterised by the presence of a complete neurovascular pedicle tra versing the gastrophrenic ligament. This relates to the gastric collat eral v., which is connected to the left renal v. via the inferior v. o f the left crus of the dia phragm and the middle capsular v., hence th e name ''gastro -phreno-capsulorenal shunt''. At an advanced stage of portal hypertension these splenorenal shunts may acquire a major calib er and behave like actual surgical shunts.