PORTAL VEINPOSITONED ANTERIOR TO THE PANCREAS AND POSTERIOR TO THE DUODENUM -REPORT OF A CASE-

Abstract

This paper describes a case of anomaly of the portal vein which was accidentally, with some etiologic discussion.
A 65-year-old man was pointed out that his stool was positive for occult blood and was diagnosed as having a cecal cancer with close examination. Preoperative ultrasonography and CT visualized a serpentine portal vein at the porta hepatis which branched into the liver like tentacles of an octopus. No abnormality was revealed by an angiography of the celiac artery. Portography revealed a displacement of the vein to the right at the posterior margin of the pancreas, showing a L-shaped appearance, and it parted right and left at the anterior margin of the pancreas. At laparotomy the right and left portal veins positioned anterior to the common bile duct and then anterior to the pancreatic head through posterior to the duodenal bulb. With a diagnosis of cecal cancer associated with anomaly of the portal vein, a right hemicolectomy was performed. The excised specimen revealed both right and left portal veins ran anterior to the common bile duct at the ligamentum hepatoduodenale and then posterior to duodenum. There was no morphological abnormality of the liver nor displacement of the gallbladder. During the operation the portal pressure was 130mmH₂O. It was etiolgically through that the patients had portal veins positioned anterior to the pancreas and posterior to the duodenum. It is so rare that only four cases including our case have been reported in the Japanese literature so far.