Refractory duodenal obstruction and severe malnutrition secondary to a preduodenal portal vein and intestinal malrotation in an adolescent: a case report

The preduodenal portal vein (PDPV) is a rare congenital vascular malformation that can lead to duodenal compressive obstruction. Due to its atypical clinical presentation, it is difficult to diagnose with routine examinations and typically requires advanced imaging or intraoperative exploration for confirmation. Malrotation of the intestine is a congenital gastrointestinal malformation that may cause intestinal obstruction due to volvulus. When preduodenal portal vein coexists with intestinal malrotation, it can further exacerbate the challenges in diagnosing and treating the patient's conditionasd. This report presents a case of duodenal obstruction caused by preduodenal portal vein (PDPV) associated with intestinal malrotation. The patient was a 17-year-old male who presented with recurrent nausea, vomiting, and significant weight loss over the past year. Preoperative imaging suggested duodenal obstruction and multiple vascular abnormalities, but the specific etiology remained unclear. After multiple unsuccessful conservative treatments, surgical intervention was decided upon. Intraoperative laparoscopic exploration revealed intestinal malrotation and a PDPV causing duodenal obstruction. A gastrojejunostomy combined with a Braun anastomosis was performed to bypass the obstructed segment. Postoperatively, the patient's symptoms improved, and his nutritional status significantly enhanced. PDPV associated with intestinal malrotation is a rare cause of refractory duodenal obstruction and severe malnutrition. Detailed imaging and timely surgical intervention are crucial for diagnosis and effective treatment.