An Unusual Case of Persistent Vitelline Vein in a Pediatric Liver Transplant Recipient: A Case Report.

The portal vein is crucial for supplying the liver, and its embryonic development is complex. Variations in portal vein formation can lead to significant surgical challenges, particularly in liver transplantation. Here, we report a unique case of a persistent left portal vein in a 2-year-old patient with Alagille syndrome. During the recipient hepatectomy, the portal vein was found to have an unusual course, traversing behind the pancreas with a more caudal confluence than typical. Although no adverse outcomes occurred during transplant, this variation required a longer and more angular anastomosis, potentially increasing the risk of tension, torsion, and angulation. These variations may contribute to complications, such as anastomosis failure or increased vascular injury. Although no vascular complications arose in this case, the persistence of the left portal vein underscores the importance of surgeons recognizing embryological variations. Preoperative radiological assessment is crucial for anticipating potential challenges, ensuring a safer surgical procedure, and improving patient outcomes.