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Unusual association of diseases/symptoms
CASE REPORT
Congenital or acquired? Obstructive jaundice in reoperated duodenal atresia
  1. Mervin Feng Ji Goh,
  2. Malcolm Han Wen Mak,
  3. Yee Low and
  4. Caroline Choo Phaik Ong
  1. Paediatric Surgery, KK Women’s and Children’s Hospital, Singapore
  1. Correspondence to Dr Mervin Feng Ji Goh, mervin.goh{at}mohh.com.sg

Abstract

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.

  • congenital disorders
  • paediatric surgery

https://doi.org/10.1136/bcr-2019-231021

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    Footnotes

    • Contributors All the authors were involved in the operation and contributed to postoperative care. MFJG was involved in the write-up and preparation for submission. MHWM and YL were responsible for planning and editing the manuscript. CCPO was the lead consultant in charged of the patient’s care and was involved in obtaining patient consent and editing of the manuscript for submission. All authors read and approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Obtained.