Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
World J Gastrointest Oncol. Sep 15, 2026; 18(9): 121292
Published online Sep 15, 2026. doi: 10.4251/wjgo.121292
Preoperative vascular simulation for distal bile duct cancer with a preduodenal portal vein: A case report
Shinnosuke Harata, Yoichi Matsuo, Haruka Shigemori, Tomofumi Kaneko, Haruka Kirihara, Ryo Nakajima, Shigeyuki Kosaka, Kaori Watanabe, Yushi Yamakawa, Kenta Saito, Tomoya Shamoto, Kazuyoshi Shiga, Takafumi Sato, Hiroyuki Sagawa, Tatsuya Tanaka, Kazuki Hayashi, Shuji Takiguchi
Shinnosuke Harata, Yoichi Matsuo, Haruka Shigemori, Haruka Kirihara, Ryo Nakajima, Shigeyuki Kosaka, Kaori Watanabe, Tomoya Shamoto, Kazuyoshi Shiga, Tatsuya Tanaka, Department of Gastroenterological Surgery, Nagoya City University East Medical Center, Nagoya 464-8547, Aichi, Japan
Tomofumi Kaneko, Kazuki Hayashi, Department of Gastroenterology, Nagoya City University East Medical Center, Nagoya 464-8547, Aichi, Japan
Yushi Yamakawa, Kenta Saito, Takafumi Sato, Hiroyuki Sagawa, Shuji Takiguchi, Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Aichi, Japan
Author contributions: Harata S and Matsuo Y conceived and designed the study; Harata S collected the clinical data and drafted the manuscript; Shigemori H, Kaneko T, Kirihara H, Nakajima R, Kosaka S, Watanabe K, Yamakawa Y, Saito K, Shamoto T, Shiga K, Sato T, Sagawa H, Tanaka T, and Hayashi K contributed to data interpretation and manuscript revision; Takiguchi S supervised the study. All authors have read and approved the final manuscript.
AI contribution statement: ChatGPT was used only to assist with English wording, sentence refinement, organization of the text, and formatting during manuscript preparation and revision. It was not used for study design, data collection, data analysis, interpretation of the findings, or preparation of the scientific content, including the results, discussion, conclusions, or references. All text generated with AI assistance was carefully checked and revised by the authors, who accept full responsibility for the accuracy, originality, and integrity of the manuscript.
Informed consent statement: Informed written consent was obtained from the patient.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Yoichi Matsuo, MD, PhD, Professor, Department of Gastroenterological Surgery, Nagoya City University East Medical Center, 1-2-23 Wakamizu, Chikusa-ku, Nagoya 464-8547, Aichi, Japan.
matsuo@med.nagoya-cu.ac.jp
Received: March 23, 2026
Revised: May 6, 2026
Accepted: June 25, 2026
Published online: September 15, 2026
Processing time: 156 Days and 15.3 Hours
BACKGROUND
Preduodenal portal vein (PDPV) is a rare congenital vascular anomaly in which the portal vein courses anterior to the duodenum. This anomaly may increase the risk of catastrophic vascular injury during pancreaticobiliary surgery, particularly when accompanied by additional anatomical abnormalities.
CASE SUMMARY
A 67-year-old man presented with progressive jaundice and was diagnosed with distal bile duct cancer. Contrast-enhanced computed tomography revealed a PDPV, celiac axis stenosis due to median arcuate ligament syndrome, intestinal malrotation, polysplenia, and severe hypoplasia of the pancreatic body and tail. Based on careful review of the original computed tomography dataset and three-dimensional imaging, a preoperative schematic illustration-based vascular simulation was created to integrate complex anatomical and hemodynamic findings and assess the extent of preservable pancreatic parenchyma. Because the pancreatic body and tail were markedly hypoplastic, and preservation of a functionally adequate pancreatic remnant was considered unfeasible, total pancreatectomy was selected. Intraoperatively, the anomalous portal vein and prominent pancreaticoduodenal collaterals were confirmed, and total pancreatectomy was completed safely after verification of adequate hepatic arterial inflow. Histopathology revealed distal bile duct cancer (pT3N0M0) with negative margins, consistent with R0 resection.
CONCLUSION
Preoperative illustration-based vascular simulation can facilitate safe and individualized surgical planning in pancreaticobiliary malignancies associated with PDPV.
Core Tip: Preduodenal portal vein is an extremely rare congenital vascular anomaly that can complicate pancreaticobiliary surgery. We report a case of distal bile duct cancer with preduodenal portal vein and multiple congenital anomalies, including median arcuate ligament syndrome, intestinal malrotation, polysplenia, and pancreatic hypoplasia. Preoperative illustration-based vascular simulation, generated through careful review of the original computed tomography dataset, enabled precise understanding of the anomalous anatomy and clinically relevant collateral flow patterns. This directly influenced the surgical strategy, allowing safe completion of total pancreatectomy. This case highlights the practical value of careful preoperative vascular assessment and surgeon-directed schematic integration in complex pancreaticobiliary surgery.
