Haldun KAR, Necat CİN, Yasin PEKER, Evren DURAK, Özgün AKGÜL, Halis BAĞ, Fatma TATAR

Coincidence of right adrenal vein and retroaortic left renal vein variations in a patient undergoing laparoscopic adrenalectomy

Bu olguda, laparoskopik sağ adrenalektomi sırasında karşılaşılan dikkate değer sağ adrenal ven varyasyonu ile birlikte renovasküler varyasyonu sunmayı amaçladık. Altmış sekiz yaşında bayan hasta, sağ adrenal kitle tanısı ile tedavi amaçlı kliniğimize yatırıldı. Batın tomografisinde sağ adrenal bezde 3x4.5x3.5 cm boyutlarında solid kitle ve retroaortik sol renal ven tespit edildi. Hastaya laparoskopik transabdominal sağ adrenalektomi planlandı. Laparoskopik eksplorasyon sırasında adrenal bezden vena cava inferiora venöz drenaj izlenmedi. Disseksiyon tamamlandığında sağ adrenal venin aksesuar sağ hepatik vene açıldığı görüldü. Adrenal ven varyasyonları ile ilişkili sol retroaortik renal ven varyasyonu literatürde birkaç yayında rapor edilmekle birlikte, aksesuar sağ hepatik vene açılan sağ adrenal ven varyasyonu ile sol retroaortik renal ven varyasyon kombinasyonu çok daha nadir görülen bir durumdur.

Laparoskopik adrenalektomi yapılan bir hastada sol retroaortik renal ven ve sağ sürrenal ven varyasyonunun rastlantısal birlikteliği

In this case, we report an interesting right adrenal vein variation with renovascular variations discovered during the laparoscopic right adrenalectomy. A Sixth eight- year-old woman was referred for treatment of a right adrenal mass. Computed tomography sections revealed 3x4.5x3.5 cm well defned right adrenal mass and ret- roaortic left renal vein. Conventional laparoscopic trans - abdominal approach was scheduled. During the laparoscopic exploration It was noted that there was no vein drainage from adrenal gland to the inferior vena cava. As this dissection completed, right adrenal vein was exposed arisen from accessory right hepatic vein. In some reports ıt has been reported that adrenal vein variations can be associated with retroaortic left renal vein, but the right adrenal vein joined with an accessory right hepatic vein and retroaortic left renal vein combination is extremely uncommon condition.

PDF

___

1. MacGillivray DC, Khwaja K, Shickman SJ. Confuence of the right adrenal vein with the accessory right hepatic veins. A potential hazard in laparoscopic right adrenalectomy. Surg Endosc 1996;10:1095-1096.
2. Penbegül N, Kılınç F, Yıldırım K, et al. Laparoscopic adre - nalectomy: Our clinical experiences with the frst 10 pa - tients. Dicle Medical Journal 2012;39:567-570
3. Sèbe P, Peyromaure M, Raynaud A, Delmas V. Anatomical variations in the drainage of the principal adrenal veins: the results of 88 venograms. Surg Radiol Anat 2002;24:222- 225.
4. Nam JK, Park SW, Lee SD, Chung MK. The clinical sig - nifcance of a retroaortic left renal vein. Korean J Urol 2010;51:276-280.
5. Yi SQ, Ueno Y, Naito M, et al. The three most common variations of the left renal vein: a review and meta-analysis. Surg Radiol Anat 2012;34:799-804.
6. Scholten A, Cisco RM, Vriens MR, et al. Variant Adrenal Venous Anatomy in 546 Laparoscopic Adrenalectomies. JAMA Surg 2013;148:378-383.
7. Nakamura S, Tsuzuki T. Surgical anatomy of the hepatic veins and the inferior vena cava. Surg Gynecol Obstet 1981;152:43-50.
8. Matsuura T, Takase K, Ota H, et al. Radiologic anatomy of the right adrenal vein: preliminary experience with MDCT. AJR Am J Roentgenol 2008;191:402-408.
9. Dilli A, Ayaz UY, Kaplanoglu H, et al. Evaluation of the left renal vein variations and inferior vena cava variations by means of helical computed tomography. Clinical Imaging 2013;37:530-535.
10. Cesmebası A, Plessis MD, Iannatuono M, et al. A review of the anatomy and clinical signifcance of adrenal veins. Clin Anatomy 2014;27:1253-1263
11. Satyapal KS, Kalideen JM, Haffejee AA, et al. Left renal vein variations. Surg Radiol Anat 1999;21:77-81.