Preduodenal portal vein: a 3-case series demonstrating varied presentations in infants
A 10-month-old boy presented to the emergency room with abrupt onset of bilious vomiting. He was born at 39 weeks of gestation by normal vaginal delivery. A complex cardiac anomaly with complete atrioventricular septal defect and malposition of the great arteries was identified during prenatal care, which was surgically corrected at 8 months of age. No obvious gastrointestinal symptoms had occurred previously. Clinical evaluation for vomiting - included upper gastrointestinal (UGI) series radiography, endoscopy, and abdominal computed tomography, these suggested a duodenal obstruction, such as a web. Surgical exploration revealed nonfixation of the midgut without volvulus and no dilatation of the duodenum, however vascular structures and the bile duct were observed to cross over the duodenum with compressing it. The vascular structures were confirmed to be a portal vein and hepatic artery (). Subsequently, gastroduodenostomy was performed to allow these structure lie posterior to the anastomosis site after full mobilization of the duodenum. The postoperative course was uneventful and discharged at 10 days after operation.