Preduodenal portal vein: a case series of variable clinical presentations and surgical implications

Area of Science:

• Pediatric Surgery
• Gastrointestinal Surgery
• Vascular Anomalies

Background:

• Preduodenal portal vein (PDPV) is a rare congenital anomaly.
• PDPV can be asymptomatic or cause significant gastrointestinal issues.
• Association with other congenital anomalies, such as extrahepatic biliary atresia (EHBA), is noted.

Purpose of the Study:

• To report a case series of pediatric patients with PDPV.
• To illustrate the diverse clinical presentations and surgical management strategies for PDPV.
• To emphasize the importance of intraoperative recognition of PDPV.

Main Methods:

• Retrospective review of four pediatric cases with PDPV.
• Analysis of clinical presentations, intraoperative findings, and surgical interventions.
• Correlation of PDPV with associated anomalies and obstructive symptoms.

Main Results:

• Two cases of PDPV were incidentally found during surgery for EHBA and required no specific intervention.
• Two cases presented with duodenal obstruction; one due to PDPV compression, managed with laparoscopic duodenoduodenostomy.
• One case of duodenal obstruction was due to malrotation, with PDPV noted but not causative; treated with Ladd's procedure.

Conclusions:

• PDPV exhibits variable clinical manifestations, from incidental intraoperative findings to significant duodenal obstruction.
• Accurate intraoperative identification of PDPV is critical for surgical planning and patient safety.
• Management should be tailored based on whether PDPV is the obstructing factor or an incidental finding, especially in the presence of other anomalies.