Preduodenal portal vein (PDPV) is a rare anomaly in which the portal vein courses anterior to the second part of the duodenum. PDPV is often associated with other congenital anomalies such as polysplenia, malrotation and pancreatic anomalies. We report an elderly male with Stage IIB esophageal adenocarcinoma. Incidental findings on staging computed tomography (CT) included an anomalous preduodenal and presplenic portal vein and polysplenia, though the patient did not present with any symptoms related to these findings. Post-neoadjuvant chemoradiation, the patient underwent an Ivor Lewis esophagectomy. Appreciating the anomalous tract of the portal vein anterior to the pancreas and duodenum from the preoperative images, we were able to perform duodenal mobilization (Kocher manuever) without vessel injury. Since, PDPV is often an asymptomatic and incidental finding in adults, serious surgical complications may occur if not appreciated on preoperative imaging or intraoperatively. Heightened awareness of PDPV and other associated anomalies remains vital to a safe procedure in all ages.

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