Congenital anomalies involving the portal vein (PV), particularly those occurring beyond its bifurcation, are extremely rare. Among these, the duplication of the PV has only occasionally been reported. We present a distinct case observed on contrast-enhanced computed tomography (CECT), in which three separate PVs were identified. In this unusual configuration, the superior mesenteric vein joined the inferior mesenteric vein to form a single venous trunk. This trunk is then divided into two branches: one continued directly into the liver as an independent PV-3, whereas the other joined the splenic vein (SV). The confluence of this second branch with the SV formed a short segment of the main PV, which subsequently split into two hepatic branches (PV-1 and PV-2). All three veins entered the liver and were connected via multiple intrahepatic venous bridges, resulting in a complex network rather than the typical dichotomous pattern. Recognizing such rare venous variants is of significant clinical importance. In the setting of living donor liver transplantation, this particular anomaly presents a major contraindication to donor hepatectomy. Ensuring sufficient portal flow to both the donor remnant and the graft is unfeasible, posing serious risks to the viability of both. Any attempt at graft retrieval would necessitate intricate vascular reconstruction, increasing surgical complexity and associated risks. From both surgical and radiological perspectives, awareness and precise preoperative assessment – particularly with CECT and three-dimensional imaging – are essential to avoid misinterpretation and to support safe, informed decision-making.
Soni et al. (Thu,) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: