A Case of Carcinoma of the Bile Duct with Anomaly of the Portal Venous System-Prepancreatic, Postduodenal Portal Vein-

Norichika Matsui, Tomoaki Morita, Mikihiko Harada, Noriyasu Morikage, Mamoru Kanazawa, Takashi Nakamura, Toshihiro Kaneyuki

Department of Surgery, Kouseiren Shuhtoh General Hospital

Anomalies of the portal venous system are rare. We report a very rare surgical case of the carcinoma of the bile duct associated with the portal vein, namely the prepancreatic postduodenal portal vein, being abnormally situated. A 66-year-old woman came for treatment of upper abdominal pain. On admission, she was found to have jaundice, and found after various examinations, carcinoma at the middle and inferior bile duct. The superior mesenteric-portal venogram revealed very unusual sight. The portal vein, which was deviated to the right below the margin of the head of the pancreas forming an L-shape, branched off to right and left just above the margin of the head of the pancreas and streamed, in azigzag pattern into the liver. The spleno-portal venogram showed that the splenic vein was streamed in left portal vein and a tumor embolism was discerned at the confluence. Pancreaticoduodenectomy combined with resection of the portal vein was performed. The portal vein was situated in a prepancreaticpostduodenal position, and lay in a position anterior to the common bile duct in the hepatoduodenal ligament. Clinically, the portal vein is very important in digestive surgery, and therefore it is essential to recognize and be aware of anomalies in the portal venous system such as anteroposition seen in this case, in order to avoid accidental injuries during operations.

Key words
anomaly of the portal venous system, prepancreatic postduodenal portal vein, anteroposi tion of the portal vein

Reprint requests
Norichika Matsui Department of Surgery, Kouseiren Shuhtoh General Hospital
1000-1 Kogaisaku, Yanai, 742 JAPAN

Accepted
June 14, 1995

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