Preduodenal portal vein causing symptomatic duodenal obstruction in an adult: a case report

Preduodenal portal vein (PDPV) is a congenital anomaly where the portal vein (PV) crosses anterior to the first part of the duodenum. It is commonly associated with other congenital anomalies, typically presenting as a duodenal obstruction in infancy. While rare, PDPV can be diagnosed in adulthood, but is usually asymptomatic and found incidentally during surgery or on imaging. We present a case of chronic postprandial abdominal pain, occasional vomiting, and early satiety in a middle-aged female due to PDPV causing a partial duodenal obstruction. She also had malrotation of the bowel, partial agenesis of the dorsal pancreas, and azygous continuation of the inferior vena cava. We performed a laparoscopic gastrojejunostomy to bypass the obstruction caused by PDPV, resolving the patient's preoperative symptoms, now with over 3 years' follow-up. Persistent and unexplained abdominal complaints in adults warrant thorough investigation for uncommon causes such as PDPV and other congenital anomalies.