Ann Hepatobiliary Pancreat Surg.  2021 Feb;25(1):145-149. 10.14701/ahbps.2021.25.1.145.

A potential intraoperative disaster averted: Preduodenal portal vein compressing a preduodenal common bile duct

• Kumar A
• Pandey M

• KMID: 2513189
• DOI: http://doi.org/10.14701/ahbps.2021.25.1.145

Abstract

Familiarity with the anatomy is paramount for conduct of safe surgery for a surgeon. Anomalies with the biliary and hepatic arterial system are common but portal vein anomalies are least common. A preduodenal portal vein has been reported in about 100 cases but a combination of preduodenal portal vein with preduodenal common bile duct is extremely rare with only 9 cases being reported. We report a one such case and discuss the embryological basis for the peculiar anatomy observed in our case which has never been reported earlier. We also reviewed the reported cases in literature.

Keyword

Preduodenal portal vein; Preduodenal common bile duct; Jaundice; Choledocholithiasis; Choledochojejunostomy

Figure

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  Fig. 1 Intraoperative picture showing preduodenal portal vein (PD PV) and preduodenal CBD. PD PV (black star) to the right of PDCBD (white star). The duodenum (D) is coursing behind and pancreas (P) is in front of these structures.

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  Fig. 2 Pre-operative imaging of the patient. (A) Axial CT scan image showing portal vein (P) and CBD (C) in front of duodenum (D) and pancreas (Panc). (B) Coronal reformatted CT scan image showing portal vein (P) crossing the CBD (C) and causing compression. Both these structures are in front of duodenum (D) and pancreas (Panc). (C) MRI T2 weighted axial image showing choledocholithiasis (white star) and portal vein (white arrow) to right of CBD. S, stomach; G, Gallbladder.

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  Fig. 3 Illustration showing the embryological development. (A) Development of a normal (PV) and preduodenal portal vein (PDPV) from the paired vitelline veins. (B) Development of CBD and pancreas with normal counterclockwise rotation of the duodenum. (C) Reverse rotation during development leading to a preduodenal portal vein and CBD in our case (blue–portal vein; yellow–CBD; pink–pancreas; brown–liver, and orange–stomach/duodenum).

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