A Case of Carcinoma of the Ampulla of Vater with Anomaly of the Portal Venous System: Prepancreatic Postduodenal Portal Vein

• Published in: The Japanese Journal of Gastroenterological Surgery Vol. 47; no. 5; pp. 275 - 280
• Main Authors: Shimizu, Dai, Fujii, Tsutomu, Suenaga, Masaya, Niwa, Yukiko, Okumura, Norio, Kanda, Mitsuro, Yamada, Suguru, Takeda, Shin, Kodera, Yasuhiro
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society of Gastroenterological Surgery 01.05.2014
• Subjects: anomaly of the portal vein; pancreatoduodenectomy; prepancreatic postduodenal portal vein
• ISSN: 0386-9768; 1348-9372
• DOI: 10.5833/jjgs.2013.0229

Prepancreatic postduodenal portal vein is a very rare anomaly, having only 10 reported cases including our case. We report a surgical case of carcinoma of the ampulla of Vater with a prepancreatic postduodenal portal vein. An 85-year-old woman was admitted for treatment of carcinoma of the ampulla of Vater. Preoperative enhanced CT showed the portal vein passing to the ventral pancreas and to the dorsal duodenum, and three-dimensional reconstruction of the portal vein showed an L-shaped curve. Subtotal stomach-preserving pancreatoduodenectomy was performed. It was difficult to exfoliate the portal vein from the pancreas and bile duct because the portal vein wall was fragile and thin, and its adhesion to the surrounding tissue was extremely strong. As a result, portal vein thrombosis occurred and resection of the portal vein was performed despite the absence of cancer invasion. We resected and reconstructed the portal vein repeatedly, but portal vein thrombosis occurred again. Fortunately, bowel necrosis was avoided and the patient recovered, although strict postoperative management was required. It was suggested that prepancreatic postduodenal portal vein might result in complications such as hemorrhage and thrombosis during surgical procedures for treating the hepatoduodenal ligament, because of fragility, thinness and strong adhesion of the portal vein wall. Prepancreatic postduodenal portal vein is easy to diagnose by preoperative enhanced CT, however, it is necessary to carefully consider the surgical procedure and the indications.