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Prepancreatic postduodenal portal vein: a case report and review of the literature
© The Author(s). 2016
Received: 15 July 2016
Accepted: 30 November 2016
Published: 4 January 2017
Prepancreatic postduodenal portal vein is extremely rare, with only 13 cases reported in the literature.
A 55-year-old white woman presented to our emergency department with abdominal pain. She underwent a computed tomography of her abdomen, which showed a portal vein coursing anterolaterally to her pancreas and posteriorly to the first portion of her duodenum, constituting a prepancreatic postduodenal portal vein. Imaging revealed choledocholithiasis, requiring endoscopic sphincterotomy, but due to a history of a gastric bypass procedure, she was lost to follow-up after being referred to an advanced endoscopist. This represents the 14th reported case of prepancreatic postduodenal portal vein.
Awareness of this rare anomaly is paramount, and will help surgeons and interventional radiologists to avoid complications related to inadvertent injury to the portal vein, which could be life-threatening.
Anatomical variants of the portal vein (PV) are rare and one of the least common of these is the development of a prepancreatic postduodenal portal vein (PPPV), an anomaly in which the PV lies anterior to the pancreas and posterior to the duodenum instead of being posterior to both the pancreas and the duodenum. Awareness of this very rare anomaly is very important especially prior to any surgical or percutaneous interventions involving the biliary tree, liver, or pancreas, to avoid potentially devastating injuries to the PV which could result in liver ischemia or massive hemorrhage. We found only 13 cases reported in the literature, and add this 14th case [1–12].
A 55-year-old white woman presented to our emergency department with acute onset of abdominal pain, which was associated with nausea and multiple bouts of emesis. Her past medical history included deep venous thrombosis currently treated with warfarin and a history of rheumatoid arthritis. She stopped smoking tobacco 10 years prior to presentation and she denied any significant alcohol intake. She had no relevant environmental exposures. Her past surgical history was significant for a Roux-en-Y gastric bypass (RYGB).
Cases of prepancreatic postduodenal portal vein
Age and gender
How it was discovered
Brook and Gardner 
Matsumoto et al. 
Carcinoma of the bile duct
Dumeige et al. 
Matsui et al. 
Carcinoma of the bile duct
Yasui et al. 
Ozeki et al. 
Liver metastasis from rectal cancer
Tanaka et al. 
Carcinoma of the bile duct
Inoue et al. 
Jung et al. 
Tomizawa et al. 
Colorectal metastasis to the liver
Jain et al. 
Shimizu et al. 
Carcinoma of ampulla of Vater
Despite the rarity of PPPV, familiarity of this anomaly is paramount. Knowledge of this anatomic variation and other PV anomalies will help surgeons and interventionalists to avoid catastrophic complications related to inadvertent injury to the PV resulting in massive hemorrhage or ischemic complications to the liver or bowel.
The authors thank Dr Mohammad Naseem for a careful and thorough review of the imaging in the figures.
No sources of funding for the research reported exist.
Availability of data and materials
Authors will make readily reproducible materials described in the manuscript freely available to any scientist wishing to use them, without breaching participant confidentiality.
SC conceived of the project. NG and SC participated in the design of the study. NG and SC participated in its design and coordination and helped to draft the manuscript. Both authors read and approved the final manuscript.
The authors declare that they have no competing interests.
Consent for publication
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
Ethics approval and consent to participate
This project was reviewed and approved by the Saint Agnes Institutional Review Board, consistent with Policy Number 7.8 on Case Reports.
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