Laparoscopic adrenalectomy in a case of congenital duplication of the inferior vena cava. Case report

Abstract

INTRODUCTION: Congenital duplication of the inferior vena cava is frequently associated with other vascular anomalies of its venous tributaries. Awareness of such occurrence facilitates laparoscopic surgery and avoids inadvertent vascular injuries.

CASE REPORT: An adrenal mass of increasing size was discovered in a 39 years old lady previously submitted to restorative proctocolectomy for Familial Polyposis Coli. Since the first preoperative work up, Computerized Tomography showed a duplicated inferior vena cava as well as other visceral and vascular anomalies. During laparoscopic adrenalectomy a double adrenal vein was discovered: the first one draining normally into the vena cava and the second one into the righ renal vein. Both of them were clipped and divided and surgical outcome was succesful.

DISCUSSION: The progress in cross-sectional imaging made easily recognisable congenital anomalies of the inferior vena cava in patients otherwise asymptomatic. Its occurrence has been evaluated through previous reports on venous anomalies during adrenal and renal surgery as well as through angiographic studies. Knowledge of these anomalies is very important for interventional radiologists, urologists and for general surgeons. However when facing adrenal surgery the operator should be aware that a double vein can be found in up to 10% of the cases and such occurrence is more predictable in case of pheochromocytoma and of large adrenal mass. Surgeons should rely both on preoperative dignostic imaging and careful dissection through laparoscopic magnified view to avoid harmful bleeding complications.