Prepancreatic postduodenal portal vein: a new hypothesis for the development of the portal venous system

Tomizawa, Nobuo; Akai, Hiromu; Akahane, Masaaki; Ino, Kenji; Kiryu, Shigeru; Ohtomo, Kuni

doi:10.1007/s11604-009-0386-4

Cited by 15 publications

(7 citation statements)

References 7 publications

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“…The presumptive SMV, together with the SV, is considered to be an affluent of the distal, postduodenal portion of the left vitelline vein or the successor of the vitelline vein itself . Major attention in the literature has been paid to different types of preduodenal and/or prepancreatic portal veins , with less focus on the double SMV. It has been postulated that such variations arise from the persistence of distal portions of both vitelline veins, as well as from the ventro‐caudal anastomosis between them .…”

Section: Discussionmentioning

confidence: 99%

Navigating the mesentery: part II. Vascular abnormalities and a review of the literature

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Navigating the mesentery: part II. Vascular abnormalities and a review of the literature

et al. 2017

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“…b). Next, rotation of the pancreatic buds progresses, and then the dorsal pancreas rotates clockwise around the duodenum and appears from the anterior surface of the caudal part of the left vitelline vein, which forms the future superior mesenteric vein (Dickson, ; Marks, ; Hashimoto and Yura ; Collardeau‐Frachon and Scoazec, ; Tomizawa et al ; Fig. c).…”

Section: Discussionmentioning

confidence: 99%

Morphological analysis of the branches of the dorsal pancreatic artery and their clinical significance

et al. 2013

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The dorsal pancreatic artery (DP), characterized by a course that crosses behind the proximal part of the splenic vein. It is regarded as clinically important, providing essential distribution to the pancreas. However, the origin of the DP is extremely variable and therefore cannot provide a sufficient basis for identifying it. The DPs of 11 cadavers were investigated in terms of origin, course and distribution. A total of 45 branches of the DP are classified into seven types on the basis of course and distribution. One of these seven types was consistently observed among the specimens: it ran to the right, passed behind the superior mesenteric vein and anterior surface of the posterior part of the head of the pancreas, and then distributed to the uncinate process and the posterior part of the head of the pancreas. Variations in the branching pattern of the DP can be explained from the following perspective: the consistent branch (#5) is the stem of the DP, and other branches originate from it. It is advisable for surgeons to pay attention to this consistent branch of the dorsal pancreatic artery when performing a pancreaticoduodenectomy.

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“…A PPPV is often detected as an L-shaped or inverted L-shaped PV by contrast-enhanced CT [ 9 , 10 ]. Additionally, PPPV cases often exhibit early PV branches or cavernous transformations around the portal hepatis or a junction between the SMV and SPV [ 11 ]. These features allow for easy radiological identification of PPPV.…”

Section: Discussionmentioning

confidence: 99%

Hepatobiliary-pancreatic surgery for patients with a prepancreatic postduodenal portal vein: a case report and literature review

et al. 2022

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Background Prepancreatic portal vein (PPV) is a congenital anatomical variant of the portal vein (PV). PPVs are extremely rare and generally classified into two categories, prepancreatic preduodenal portal vein and prepancreatic postduodenal portal vein (PPPV). Prepancreatic preduodenal portal veins are rare, with approximately 100 reported cases globally; PPPVs are even more atypical, with less than 20 documented cases globally. Despite the extremely low occurrence, PPPV knowledge and recognition are important, especially for hepatobiliary-pancreatic (HBP) surgeries, such as pancreaticoduodenectomy (PD) for patients of a PPPV. Here, we report a case of PPPV and a literature review. Case presentation A 73-year-old-male with ampullary carcinoma underwent PD at our hospital. Preoperative enhanced CT revealed an abnormal L-shaped PV, identified as a PPPV. Both the PPPV and the postpancreatic “normal” superior mesenteric vein (SMV) divaricated from the SMV at the caudal side of the pancreas. A splenic vein and inferior mesenchymal vein flowed into the postpancreatic “normal” PV, which encircled the common bile duct and potentially flowed into the liver, forming a cavernous transformation at the hilar plate. During surgery, we attempted to isolate the PV from the pancreas and common bile duct. However, it was difficult to isolate from the pancreas. The PPPV was so fragile that bleeding from the PPPV became uncontrollable. To remove the tumor, we resected the PPPV and reconstructed a “normal” PV as an autogenous graft. To maintain intraoperative hepatic blood flow and avoid small bowel congestion, an antithrombogenic bypass catheter was placed between the SMV and umbilical vein during reconstruction. After surgery, several complications occurred, such as PV thrombosis and hyperammonemia. The patient was discharged on postoperative day 45. Conclusions PPPV is a rare vascular variant but is easily diagnosed preoperatively due to its distinct shape on CT imaging. However, isolating the PPPV from the pancreas and bile duct is incredibly difficult and potentially associated with increased operative risks and postoperative complications. PV resection rather than isolation is a potential solution to reduce the risk of hemorrhage, even in the absence of invasion.

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Prepancreatic postduodenal portal vein: a new hypothesis for the development of the portal venous system

Cited by 15 publications

References 7 publications

Navigating the mesentery: part II. Vascular abnormalities and a review of the literature

Navigating the mesentery: part II. Vascular abnormalities and a review of the literature

Morphological analysis of the branches of the dorsal pancreatic artery and their clinical significance

Hepatobiliary-pancreatic surgery for patients with a prepancreatic postduodenal portal vein: a case report and literature review

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