[A Case of Distal Bile Duct Cancer Associated with Preduodenal Portal Vein]

A 74-year-old male patient was referred to our hospital for the evaluation of abnormal liver function and dilated intrahepatic bile ducts. Imaging revealed distal bile duct carcinoma with anatomic variants, including a preduodenal portal vein, preduodenal common bile duct, abnormal bowel rotation, polysplenia, and azygos continuation of the inferior vena cava. The patient underwent a subtotal stomach-preserving pancreaticoduodenectomy. The right hepatic artery branching from the superior mesenteric artery was embolized preoperatively and dissected at its root during surgery. Intraoperative difficulty of operation, adhesion of the bile ducts and blood vessels due to inflammation, and easy bleeding have been reported in pancreaticoduodenectomy for patients with a preduodenal portal vein. For such resections, it is crucial to perform a comprehensive preoperative imaging evaluation and exercise caution during surgical maneuvers.