Repair of Preduodenal Portal Vein Injury with Polytetrafluoroethylene Graft with Midgut Rotation and Left Sided Inferior Vena Cava

Preduodenal Portal Vein (PDPV) is a rare congenital anomaly. The presence of PDPV carries the risk of injury to Portal Vein (PV) during operations involving biliary duct, duodenum and pancreas. This report is about a 50-year-old female patient with PDPV associated with midgut malrotation and left sided Inferior Vena Cava (IVC). The patient was operated for Recurrent Pyogenic Cholangitis (RPC) and associated biliary stones. The patient sustained iatrogenic injury to PV during surgery which was subsequently repaired with Polytetrafluoroethylene (PTFE) graft doppler showed patent graft at three months of follow-up. This report highlights the fact that pre-existing inflammatory conditions of bile duct and hepatoduodenal ligament further increase the risk of injury to PDPV during surgery.

Preduodenal portal vein – a cause of antenatally diagnosed duodenal obstruction

Preduodenal portal vein (PDPV) is a rare congenital vascular anomaly in which the portal vein passesanterior to the duodenum rather than posteriorly. Generally asymptomatic, PDPV may rarely cause aduodenal obstruction in the newborn. It is usually associated with gastrointestinal tract, cardiac,pancreatic, as well as biliary tract anomalies or may, occur as a single isolated malformation. Tillnow, only a few cases have been reported with duodenal obstruction and associated anomalies. Thepresent study report one such case of PDPV with multiple congenital anomalies. A full-term, one-day-old baby who had an antenatal history of polyhydramnios, presented to us with abdominaldistension and non-bilious vomitings soon after birth. Surgical exploration revealed a hugely dilatedstomach, multiple Ladd bands, malrotation of the small intestine, preduodenal portal vein, and anannular pancreas causing external duodenal compression. Intraoperative recognition of PDPV isimportant because iatrogenic injury during surgery can cause profuse hemorrhage from the vein andmay cause damage to the biliary tract or duodenal wall. Prompt evaluation of associated cardiacanomalies is important before surgery. Duodenostomy anterior to the portal vein is the definitivetreatment. Studies in animal models (AKR/J mice) have shown an autosomal recessive mode ofinheritance.

Situs Inversus Totalis with Duodenal Atresia and Preduodenal Portal Vein: A Case Report

not available DS (Child) H J 2019; 35(2) : 182-183