Preduodenal portal vein (PDPV) with preduodenal common bile duct (PDCBD) and whipple procedure. a case-report

Abstract

Introduction: Various anatomic disorders of the Portal Vein (PV) like PDPV have been described, but they are rare. Associated PDCBD is an extremely rare event. We report a patient with PDPV and PDCBD who underwent a pancreaticoduodenectomy. Presentation of the case: A 69-year-old woman presented with a tumor of the papilla of Vater was scheduled for surgery. Preoperative imaging showed a PDPV anterior to a PDCBD, arising from a pre-pancreatic confluence of the splenic and superior mesenteric vein. During pancreaticoduodenectomy, a choledochoduodenal fistula was encountered and repaired. Complete dissection and isolation of structures was possible, and there was no need for a PV reconstruction, as presented in other case reports. No postoperative complications of importance presented. Pathology confirmed a R0 resection of a non-invasive intra-ampullary papillary-tubular neoplasm (IAPN). At one-month follow-up the patient was clinically asymptomatic. Discussion: Such a discovery is often incidental and of little importance, but it takes on major importance for HPB surgeons because accidental damage of PDPV and PDCBD can lead to serious consequences. These rare disorders do not contradict Whipple procedures but should be performed by experienced surgeons with adequate preoperative imaging. Skills in PV reconstruction and its peri-operative might be beneficial for successful outcomes in some cases. Conclusion: Extended surgical procedures like a pancreaticoduodenectomy are realisable in patients with PV disorders, but require awareness, adequate radiological interpretation and specific surgical experience for secure treatment.