Surgical treatment of portal hypertension is undertaken to reduce the portal pressure to a level that allows recession of the collateral circulation. For this purpose, surgeons usually carry out anastomosis of the splenic vein with the left renal vein. The splenic vein is a large, nontortuous vessel that runs along the posterior surface of the pancreas but very rarely crosses in front of the gland. It is therefore important that a thorough preoperative study of the anatomical details of the spleno-portal venous axis be made by imaging before attempting surgery. We are presenting herewith the surgical management of a unique case of anteriorly placed splenic vein, which has not yet been described. The embryological basis of such an anomaly is discussed in this article.
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