Preduodenal portal vein

Preduodenal portal vein (PDPV) is a rare congenital vascular disorder resulting in the portal vein main trunk passing anteriorly to the duodenum .

Etiology

The precise etiology is unknown, however, it is thought to occur due to incorrect formation of the foetal vitelline veins .

Associations

Preduodenal portal vein is often part of a heterotaxy syndrome or polysplenia syndrome or associated with :

• situs inversus
• bowel malrotation
• biliary atresia
• duodenal atresia
• annular pancreas

Clinical presentation

In approximately 50% of patients, PDPV was found incidentally through laparotomy or imaging for other reasons. If patients have symptoms, they are generally pediatric and present with symptoms of duodenal obstruction .

Radiographic features

CT

On CT with contrast, the main trunk of the portal vein is seen tracking anterior to the duodenum.

Treatment and prognosis

Treatment of PDPV induced duodenal obstruction is through bypass surgery, either with gastroduodenostomy or duodenoduodenostomy .