Portacaval anastomosis

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Portacaval anastomosis

A portacaval anastomosis (also known as porto-systemic anastomosis or portal caval system) is a specific type of anastomosis that occurs between the veins of the portal circulation and those of the systemic circulation. The inferior end of the esophagus and the superior part of the rectum are potential sites of a harmful portacaval 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 hemorrhoids. Caput medusae can also result.[2]

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 Superficial epigastric vein
Retroperitoneal Splenorenal shunt[3] Splenic vein Renal vein, suprarenal vein, paravertebral vein, and gonadal vein
(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
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.


  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: 1–9. doi:10.4061/2011/960720.
  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. 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.