CASE REPORTS   

Chirurgia 2015 December;28(6):229-31

Copyright © 2016 EDIZIONI MINERVA MEDICA

lingua: Inglese

Winslow pathway development in a patient with incisional hernia

Muresan M. ¹, Muresan S. ², Neagoe R. ¹, Brînzaniuc K. ³

¹ Surgical Clinic No.2, University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, Romania; ² Physiology Department, University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, Romania; ³ Anatomy Department, University of Medicine and Pharmacy Tirgu Mureș, Tîrgu Mureș, Romania

The role of arterial anastomoses in the human body is low in normal health but becomes extremely important in vascular occlusive diseases. Anastomotic network of the abdominal wall is very rare presented in medical practice and quoted in medical literature. In this paper we present a case of abdominal aorta occlusion with parietal arterial collateral circulation development. Our patient, P.I., was admitted with a diagnosis of incisional hernia, intermittent after meals abdominal pain, expansive tumor formation in the postoperative scar. Ischemic character of abdominal pain has required an abdominal CT scan that revealed the presence of obstruction in the infrarenal abdominal aorta with partial preservation of the superior mesenteric artery flow and intense collateral circulation involving the parietal arteries: superior epigastric, intercostals, inferior epigastric (Winslow pathway), lumbars, iliolumbars, deep circumflex iliac and superficial epigastric witch fill up of the bilateral external iliac axis. We underwent the abdominal wall reconstruction with Prolene mesh in onlay position. The postoperative course was favorable with remission of postoperative abdominal pain after anticoagulation and vasodilator treatment. Arterial anastomotic circles are insignificant in healthy individuals but are important in the association with obstructive pathologies. Abdominal wall arterial anastomoses are developing very rare in obstructive aortic pathology, not being always functionally. When their anatomy is favorable, they are enough for lower limb revascularization through the development of two main types of anastomoses: parietal and visceral.