Sonographic Diagnosis of Preduodenal Portal Vein in Children| Stephy Publishers

 


SOJ Pediatrics and Clinical Neonatology - (SOJPCN)| Stephy Publishers


Abstract

Purpose: To clarify the role of sonography in diagnosis of Preduodenal Portal Vein (PDPV) in children.

Material and methods: We present two cases with PDPV in children proved with surgery. The first case was diagnosed retrospectively, the second one prospectively.

Results:In both cases the PDPV appears above the duodenum with convexity which is opposite of normal concave configuration of PV. Both cases appear with multiple congenital association anomalies.

Conclusion: The sonography is safe, convenient, fast, time- effective and cost- effective method for precise diagnosis of PDPV in children.

Keywords

Portal vein, Preduodenal portal vein, Annular pancreas, Duodenal web

Abbreviations

PV: portal vein; PDPV: preduodenal portal vein; AP: annular pancreas; DW: duodenal web

Introduction

Preduodenal portal vein (PDPV) is a rare anomaly in which the portal vein passes anterior to the duodenum rather than posteriorly. Generally asymptomatic, PDPV may rarely cause duodenal obstruction or may coexist with other anomalies. The PDPV can exist with Malrotation,1 Duodenal web,1,2 Situs Inversus,4 Volvulus,5 Polisplenia,6,7 Annular pancreas and Callosal agenesis8 Most of the authors stress point the significance of preoperative information of PDPV existence for the surgeons rather than as a main reason for duodenal obstruction. The imaging arsenal for diagnosis of PDPV includes venography, sonography, contrast meal with follow through, CT and MRI.

Case 1

27 days old female with multiple congenital anomalies, transferred to LWCH for evaluation and treatment. The admission radio graph of abdomen shows features of Cauda regression syndrome with absent limbo sacral segment of the spine, fused iliac bones, separated ischial bones, fracture of left femur, gas distended stomach and duodenum suggestive of partial duodenal obstruction. Bowels are seen herniated through the pelvis out (Figure 1). The first abdominal sonography shows distended duodenum with beak toward the pancreatic head, surrounded with pancreatic tissue Figure 2 suggestive of the reason for partial duodenal obstruction. The renal sonography shows fused kidneys at midline seen better posteriorly due to absent lumbar spine (Figure 3). The next step was Contrast meal with follow through: The stomach and duodenum appear dilated and separated by deep incisura which brings in mind possibility of vascular impression. In addition, the duodenum shows beak (Figure 4).

 

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