Congenital or acquired? Obstructive jaundice in reoperated duodenal atresia.
Cholangiopancreatography, Magnetic Resonance
Common Bile Duct
/ diagnostic imaging
Diagnosis, Differential
Duodenal Obstruction
/ surgery
Humans
Infant
Intestinal Atresia
/ surgery
Intestinal Obstruction
/ diagnostic imaging
Jaundice, Obstructive
/ diagnostic imaging
Laparotomy
Male
Pancreaticobiliary Maljunction
/ diagnostic imaging
Reoperation
/ adverse effects
Treatment Outcome
Ultrasonography
congenital disorders
paediatric surgery
Journal
BMJ case reports
ISSN: 1757-790X
Titre abrégé: BMJ Case Rep
Pays: England
ID NLM: 101526291
Informations de publication
Date de publication:
28 Aug 2019
28 Aug 2019
Historique:
entrez:
31
8
2019
pubmed:
31
8
2019
medline:
19
2
2020
Statut:
epublish
Résumé
A 55-day-old boy was transferred to our unit with intestinal obstruction and obstructive jaundice after two neonatal operations for duodenal atresia and intestinal malrotation. Abdominal ultrasound showed dilated intrahepatic and extrahepatic ducts with cut-off at the distal common bile duct (CBD). He underwent emergency laparotomy for adhesive intestinal obstruction with a contained abscess from mid-jejunal perforation. Biliary dissection was not attempted due to poor preoperative nutritional status. Tube cholecystostomy was created for biliary decompression. Postoperative magnetic resonance cholangiopancreatography showed dilated CBD with cut-off at the ampulla but did not demonstrate pancreaticobiliary maljunction (PBMJ). The diagnostic dilemma was whether our patient had congenital PBMJ or had developed biliary stricture from perioperative ischaemic scarring. He underwent definitive surgery at 7 months: excision of dilated CBD with Roux-en-Y hepaticojejeunal reconstruction, excisional tapering duodenoplasty and jejunostomy creation. Intraoperative finding was type I choledochal cyst and subsequently confirmed on histology. Postoperative recovery was uneventful and bilirubin levels normalised.
Identifiants
pubmed: 31466956
pii: 12/8/e231021
doi: 10.1136/bcr-2019-231021
pmc: PMC6720604
pii:
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
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