Author(s): Caroline Shin, William Cobb and Aleksander Bernshteyn

Abstract: Preduodenal portal vein (PDPV) is a rare congenital anomaly and accounts for a small portion of duodenal obstructions. A PDPV can be associated with malrotation, duodenal webs, and annular pancreas. Our case is of a 1-month-old female born at 38 weeks and 6 days with Sickle Cell Disease who presented for intermittent vomiting with associated weight loss and failure to thrive secondary to feeding intolerance. Ultrasound (US) demonstrated a pyloric channel measuring 17 mm and an anterior muscle wall thickness of 4mm, concerning for pyloric stenosis; however, gastric contents were able to pass into a dilated duodenal bulb. An upper gastrointestinal series (UGI) showed malrotation. The patient was taken to the operating room (OR) for laparoscopy with Ladd’s procedure and a preduodenal portal vein was identified. A laparoscopic duodenoduodenostomy was performed to bypass the preduodenal portal vein. The patient represented 2 months postoperatively for failure to thrive secondary to recurrent feeding difficulty. UGI was repeated and demonstrated distention of the proximal duodenum with hyperperistalsis and minimal emptying suggestive of a parietal obstruction in the duodenum. Esophagogastroduodenoscopy (EGD) was performed, and a scope was not able to pass through the duodenoduodenostomy for presumed stricture. The patient was taken to the OR for exploratory laparotomy with intraoperative EGD and a jejunal web was identified distal to the duodenoduodenostomy anastomosis. A side-to-side jejunojejunostomy was performed to bypass the web. In our review of literature, the jejunum is an uncommon site of intestinal webs and rarely associated with PDPV. Our case is one of a few identified cases of preduodenal portal vein associated with jejunal atresia.

DOI: 10.22271/27081494.2024.v6.i1a.93

Pages: 18-20 | Views: 297 | Downloads: 113

Download Full Article: Click Here