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Patient: Male, 36-year-old Final Diagnosis: Double inferior vena cava Symptoms: Asymptomatic Medication:— Clinical Procedure: — Specialty: Genetics • Radiology • Surgery Objective: Congenital defects/diseases Background: With a prevalence of about 2% to 3%, duplication is the most common anomaly associated with the inferior vena cava (IVC). In general, systemic venous anomalies are being more frequently diagnosed in asymptomatic patients. We report the case of a young man with an incidental finding of an asymptomatic duplicated IVC, along with a literature review. Case Report: A 36-year-old man was brought to our Emergency Department (ED) following a high-speed motor vehicle collision (MVC), reporting right flank and hip pain. Upon examination, the “seatbelt sign” was noticed, along with abrasions over his right side. He sustained a small-bowel mesenteric injury, for which he was admitted and was treated conservatively. A CT scan incidentally revealed a duplicate IVC (DIVC). He later underwent a laparotomy with limited right hemi-colectomy and was discharged home in good condition. Conclusions: Undiscovered and asymptomatic DIVCs pose a potential risk to patients during clinical interventions. Advancements in diagnostic imaging contribute greatly to the incidental discoveries of inferior vena cava duplication.

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Highlights Ampullary adenocarcinoma is a rare entity during pregnancy. Diagnosing ampullary adenocarcinoma in pregnancy can be quite challenging, as the symptoms may overlap with the physiological changes of pregnancy. Furthermore, the diagnostic modalities’ invasiveness & the associated radiation exposure that might harm the fetus. The best treatment modality for resectable tumors is in the form of surgery (i.e.; pancreaticoduodenectomy) that is possible during pregnancy. Yet challenging as its important to choose the appropriate time of surgery to insure the viability of the fetus without risking the progression of the disease. Another challenge that might be encountered is intra-operatively, due to the bulkiness of the uterus which makes such a procedure even more difficult to preform safely & successfully.