Department of Surgery, College of Medicine, Kaduna State University and Barau Dikko Teaching Hospital; Department of Surgery, Epsilon Specialist Hospital, Barnawa, Kaduna, Nigeria.
Department of Surgery, Epsilon Specialist Hospital, Barnawa, Kaduna, Nigeria.
Afr J Paediatr Surg. 2022 Apr-Jun;19(2):109-111. doi: 10.4103/ajps.AJPS_146_20.
Pre-duodenal portal vein (PDPV) is a rare anomaly and a rare cause of duodenal obstruction (DO), with only a few cases reported in the literature. We present an infant whose bilious vomiting persisted despite having Ladd's procedure for intestinal malrotation due to a missed diagnosis of DO from PDPV that was found at re-exploration. The patient was diagnosed with malrotation and had Ladd's procedure at 12 weeks of age, but bilious vomiting persisted post-operatively. The patient presented to us after 4 weeks, was clinically malnourished and dehydrated, resuscitation was done and re-exploratory laparotomy performed, where an obstructing PDPV was found and a duodeno-duodenostomy was performed anterior to PDPV. However, the patient died on post-operative day 7 probably from severe malnutrition due to delayed diagnosis and absence of parenteral nutrition. We conclude that PDPV may be a cause of DO in infants with malrotation and should be properly sought for during Ladd's procedure for possible bypass surgery if found.
胃十二指肠前静脉（PDPV）是一种罕见的异常，也是十二指肠梗阻（DO）的罕见原因，文献中仅报道了少数几例。我们报告了一例婴儿，由于术前漏诊 PDPV 导致 DO，尽管已经进行了 Ladd 手术治疗肠旋转不良，但仍持续胆汁性呕吐，在再次探查时发现了该病例。该患者在 12 周龄时因肠旋转不良行 Ladd 手术，但术后仍持续胆汁性呕吐。4 周后，该患者就诊，临床营养不良伴脱水，进行了复苏治疗并进行了剖腹探查术，术中发现 PDPV 梗阻，并在 PDPV 前进行了十二指肠空肠吻合术。然而，该患者术后第 7 天死亡，可能是由于诊断延迟和缺乏肠外营养导致严重营养不良。我们得出结论，PDPV 可能是伴有肠旋转不良的婴儿 DO 的原因，如果发现 PDPV，应在 Ladd 手术时适当寻找，以便进行可能的旁路手术。
