Congenital or acquired? Obstructive jaundice in reoperated duodenal atresia

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.

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Concurrent intestinal malrotation and Meckel's diverticulum presenting as acute intestinal obstruction in an adult

International Surgery Journal ◽

10.18203/2349-2902.isj20212288 ◽

2021 ◽

Vol 8 (6) ◽

pp. 1904

Author(s):

Aishwarya Emerald Manohar ◽

M. S. Kalyan Kumar ◽

V. Vijayalakshmi ◽

R. Kannan

Keyword(s):

Abdominal Pain ◽

Small Bowel ◽

Intestinal Obstruction ◽

Meckel’S Diverticulum ◽

Postoperative Recovery ◽

Meckel's Diverticulum ◽

Intestinal Malrotation ◽

Emergency Laparotomy ◽

Meckel’S Diverticulitis ◽

Subacute Intestinal Obstruction

Intestinal malrotation is the partial or complete failure of rotation of midgut around the superior mesenteric artery, while Meckel’s diverticulum is the remnant of vitellointestinal duct and concurrence of these congenital abnormalities in an adult is considered a rarity. Till date only 3 cases of concurrent intestinal malrotation and Meckel's diverticulum have been reported. We report a 18 years male who presented with a 3 day history of abdominal pain, bilious vomiting, obstipation and chronic abdominal pain on and off since 3 years of age. During the last episode which occurred 1 year back, he was diagnosed with intestinal malrotation with subacute intestinal obstruction and was treated conservatively. Examination revealed the presence of signs of peritonitis. After resuscitation, CECT abdomen was taken which showed dilated small bowel loops in the subhepatic region associated with malrotation. Emergency laparotomy revealed a Ladd's band below which the gangrenous small bowel loops 150 cm from the duodenojejunal (flexure until 5 cm proximal to the ileocecal junction) were found herniating into the subhepatic region with a Meckel’s diverticulum and a right sided DJ flexure. We proceeded with the band release and resection of gangrenous bowel followed by proximal jejunostomy with distal ileostomy. HPE was consistent with Meckel’s diverticulitis without any ectopic gastric or pancreatic mucosa. Ostomy reversal was done after 8 weeks. Patient had an uneventful postoperative recovery during both the admissions and he is on regular follow-up now.

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Congenital biliary web- a rare cause of obstructive jaundice in an infant: A case report

Journal of Pediatric and Adolescent Surgery ◽

10.46831/jpas.v1i1.7 ◽

2020 ◽

Vol 1 (1) ◽

Author(s):

Allah Ditta ◽

Muhammad Bilal Mirza ◽

Muhammad Waqas-ur-Rehman ◽

Maria Fahim ◽

Farrakh Mehmood Satar ◽

...

Keyword(s):

Obstructive Jaundice ◽

Hepatic Duct ◽

Magnetic Resonance Cholangiopancreatography ◽

Biliary Tree ◽

Postoperative Recovery ◽

Common Hepatic Duct ◽

Rare Entity ◽

Case Presentation ◽

Complete Obstruction ◽

The Common

Background: Congenital biliary web of the extra-hepatic biliary tree is becoming exceedingly rare cause of obstructive jaundice in children. Case Presentation: We report a case of 5-month-old male baby who presented with acholic stools and persistent jaundice since birth. Magnetic resonance cholangiopancreatography (MRCP) showed contracted gall bladder and focal narrowing at mid portion of the common bile duct (CBD) with proximal dilatation of biliary channels. On exploration, a complete web was found just proximal to the confluence of cystic duct and common hepatic duct causing complete obstruction of biliary tree. A Roux-en-Y hepatico-jejunostomy was done. Postoperative recovery was uneventful. Conclusion: We conclude that congenital biliary web is a rare entity and should be considered in the differential diagnosis of biliary atresia.

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Clinical utility of linear endosonography in patients with unexplained biliary dilatation and negative MRCP, with predictors for detection of neoplastic lesions

Egyptian Liver Journal ◽

10.1186/s43066-021-00164-x ◽

2022 ◽

Vol 12 (1) ◽

Author(s):

Hassan Atalla ◽

Ayman Menessy ◽

Hazem Hakim ◽

Hideyuki Shiomi ◽

Yuzo Kodama ◽

...

Keyword(s):

Invasive Procedure ◽

Magnetic Resonance Cholangiopancreatography ◽

Abdominal Ultrasound ◽

Final Diagnosis ◽

Multivariate Regression Analysis ◽

Diagnostic Dilemma ◽

Predictive Values ◽

Biliary Dilatation ◽

Asymptomatic Patients ◽

Neoplastic Lesions

Abstract Background and study aims Unexplained biliary dilatation (UBD) frequently represents a diagnostic dilemma. Linear endosonography (EUS), with its close proximity to the pancreaticobiliary system and the ability for tissue acquisition, could have a role in revealing etiologies of UBD particularly in the context of negative other non-invasive modalities. However, in such patients, the decision for this semi-invasive procedure is usually debatable and often needs justification. Thus, we aimed to evaluate the diagnostic utility of linear EUS in patients with UBD after negative magnetic resonance cholangiopancreatography (MRCP) and to delineate predictors for EUS ability to detect neoplastic lesions. Patients and methods This was a prospective diagnostic observational study between 2018 and 2021. Included patients with evidence of biliary dilatation on abdominal ultrasound and negative MRCP underwent linear EUS examination. Results were compared to the final diagnosis relied on histopathology after EUS-guided biopsy or surgery for neoplastic lesions, while ERCP, diagnostic EUS criteria plus histopathology for autoimmune pancreatitis, Rosemont criteria for chronic pancreatitis, and/or follow-up for 6 months were the gold standard tests for non-neoplastic etiologies. Logistic regression was conducted to reveal predictors of neoplasm detection by EUS. Results Sixty-one patients (mean age 60 years, 32 females) were enrolled; 13.1% of them were asymptomatic. The final diagnosis was categorized into 29 patients with and 32 without neoplasms. Sensitivity, specificity, positive, negative predictive values (PPV, NPV), and accuracy of EUS-positive findings were 98.3%, 100%, 100%, 66.7%, and 98.3%, respectively. Corresponding results for neoplasm identification were 100%, 93.8%, 93.5%, 100%, and 96.7%, respectively. The most common neoplastic etiologies were small pancreatic and ampullary masses. Common bile duct (CBD) diameter > 12.9mm and CA19-9 > 37.1 u/ML were independent predictors for pancreaticobiliary neoplasm at multivariate regression analysis. Conclusion Linear EUS appears to have a high accuracy in detecting etiologies of UBD, with higher sensitivity for small pancreatic, ampullary lesions, and CBD stones. CBD diameter > 12.9 mm and elevated CA19-9 > 37.1 u/ML should raise a concern about the presence of occult pancreaticobiliary neoplasm, and then, EUS may be warranted even in asymptomatic patients.

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Sporadic Burkitt Lymphoma Presenting with Middle Cranial Fossa Masses with Sphenoid Bony Invasion and Acute Pancreatitis in a Child

Case Reports in Oncological Medicine ◽

10.1155/2021/6610666 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Tal Dror ◽

Virginia Donovan ◽

Naomi Strubel ◽

Sucharita Bhaumik

Keyword(s):

Acute Pancreatitis ◽

Obstructive Jaundice ◽

Burkitt Lymphoma ◽

Magnetic Resonance Cholangiopancreatography ◽

B Cell Lymphoma ◽

Abdominal Ultrasound ◽

Middle Cranial Fossa ◽

Improve Patient Survival ◽

Multisystem Involvement ◽

Cranial Fossa

Acute pancreatitis in children is usually due to infection, trauma, or anatomical abnormalities and is rarely due to obstruction from malignancy. Sporadic Burkitt lymphoma (BL) is an aggressive non-Hodgkin B-cell lymphoma that usually involves the bowel or pelvis, with isolated cases presenting as acute pancreatitis. We report a case of BL in a 12-year-old male presenting as acute pancreatitis with obstructive jaundice and a right middle cranial fossa mass invading the sphenoid bone. The common bile duct in this case was dilated to 21 mm in diameter on abdominal ultrasound and to 26 mm on magnetic resonance cholangiopancreatography (MRCP), significantly greater than any value reported in the literature for BL. Given the rapidly progressing nature of BL, we emphasize the importance of recognizing heterogeneous presentations of this disease to improve patient survival. We also conclude that it is important to consider malignancy in a child with acute pancreatitis, particularly in the presence of obstructive jaundice or multisystem involvement. Other Presentations. This case report has no prior publications apart from the abstract being accepted to the 2020 SIOP (International Society of Pediatric Oncology) meeting and 2020 ASPHO conference (canceled due to the COVID-19 pandemic) and subsequently published as an abstract only in Pediatric Blood and Cancer. We have also presented the abstract as a poster presentation at our institution’s (NYU Langone Hospital—Long Island, previously known as NYU Winthrop) annual research day conference in 2020.

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Thyrotoxicosis and Choledocholithiasis Masquerading as Thyroid Storm

Case Reports in Medicine ◽

10.1155/2017/9454698 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5

Author(s):

Christian L. Horn ◽

Patricia A. Short

Keyword(s):

Abdominal Pain ◽

Magnetic Resonance Cholangiopancreatography ◽

Abdominal Ultrasound ◽

Symptomatic Improvement ◽

High Rate ◽

Thyroid Storm ◽

Thyroid Function Tests ◽

Distal Common Bile Duct ◽

The Many ◽

Endoscopic Retrograde Cholangiopancreatogram

A 26-year-old female, thirteen months postpartum, presented to the emergency department for four weeks of epigastric abdominal pain, pruritus, new onset jaundice, and 11.3 kgs (25 lbs) unintentional weight loss. On examination, she was afebrile, tachycardic, alert, and oriented and had jaundice with scleral icterus. Labs were significant for undetectable TSH, FT4 that was too high to measure, and elevated total bilirubin, direct bilirubin, alkaline phosphatase, and transaminases. Abdominal ultrasound revealed cholelithiasis without biliary ductal dilation. Treatment for presumed thyroid storm was initiated. Further work-up with magnetic resonance cholangiopancreatography (MRCP) revealed an obstructing cholelith within the distal common bile duct. With the presence of choledocholithiasis explaining the jaundice and abdominal pain, plus the absence of CNS alterations, the diagnosis of thyroid storm was revised to thyrotoxicosis complicated by choledocholithiasis. Endoscopic retrograde cholangiopancreatogram (ERCP) with sphincterotomy was performed to alleviate the biliary obstruction, with prompt symptomatic improvement. Thyroid storm is a rare manifestation of hyperthyroidism with a high rate of morbidity and mortality. The diagnosis of thyroid storm is based on clinical examination, and abnormal thyroid function tests do not correlate with disease severity. Knowledge of the many manifestations of thyroid storm will facilitate a quick and accurate diagnosis and treatment.

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Non-hodgkin lymphoma presenting with obstructive jaundice - diagnostic dilemma

HPB ◽

10.1016/j.hpb.2020.11.599 ◽

2021 ◽

Vol 23 ◽

pp. S239

Author(s):

S. Chauhan ◽

S. Jha ◽

A. Pandey ◽

S. Masood ◽

D. Kumar ◽

...

Keyword(s):

Obstructive Jaundice ◽

Hodgkin Lymphoma ◽

Diagnostic Dilemma ◽

Non Hodgkin Lymphoma

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A RARE CASE OF HETEROTOPIC PANCREATIC TISSUE CAUSING SMALL BOWEL OBSTRUCTION

10.36106/gjra/0202569 ◽

2021 ◽

pp. 4-5

Author(s):

B. Santhi ◽

M. Annapoorani ◽

Sharada bhavana

Keyword(s):

Intestinal Obstruction ◽

Rare Case ◽

Histopathological Examination ◽

Pancreatic Tissue ◽

Acute Intestinal Obstruction ◽

Emergency Laparotomy ◽

Review Of Literature ◽

Heterotopic Pancreatic Tissue ◽

Small Growth ◽

Upper Gastrointestinal

A Rare case of heterotopic pancreatic tissue of ileum causing acute intestinal obstruction has been described with a brief review of literature. A 42 yr old male patient presented to the emergency department with features of acute intestinal obstruction. After evaluation patient was taken up for emergency laparotomy which revealed a band to be arising from ileum. Furthermore, there was a small growth in the ileal wall at the site of origin of the band. Hence resection of the growth was done and followed by ileoileal anastomosis. Later on, histopathological examination of the growth revealed it to be heterotopic pancreatic tissue. Heterotopic pancreatic tissue is often an incidental nding encountered in upper gastrointestinal tract during endoscopy and surgeries. But Symptomatic ectopic pancreas of ileum is relatively rare and they very rarely present with acute symptoms as in this case

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EXPERIENCE OF EVALUATION OF PATIENTS OF OBSTRUCTIVE JAUNDICE BY SONOGRAPHY AND MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY AT A TERTIARY CARE CENTRE IN EASTERN INDIA

10.36106/ijar/7914686 ◽

2021 ◽

pp. 61-64

Author(s):

Santosh Kumar Prasad ◽

Nupur Nupur ◽

Akshit Pathak ◽

Indra Shekhar Thakur ◽

Vijay Shankar Prasad

Keyword(s):

Magnetic Resonance ◽

Obstructive Jaundice ◽

Hepatic Duct ◽

Tertiary Care ◽

Pancreatic Head ◽

Magnetic Resonance Cholangiopancreatography ◽

Stricture Formation ◽

Tertiary Care Centre ◽

Left Hepatic Duct ◽

Cross Sectional

INTRODUCTION: Jaundice means yellow due to the yellowish discolouration of skin, sclera, and mucous membrane seen in jaundice caused by bilirubin pigment. It is divided in to two forms obstructive(surgical) and non- obstructive (non-surgical). AIM AND OBJECTIVE: To evaluate patients of obstructive jaundice by sonography and magnetic resonance cholangiopancreatography and compare the reporting and ndings by both the modalities. MATERIALS AND METHODS: Cross sectional observational study done from November 2018 to October 2020 and consists of 32 patients who had clinical jaundice and consented to being subjected to both ultrasound and MRCP. OBSERVATIONS:Both USG and MRCP were able to detect extrahepatic CBD dilatation equally in 25 patients. In 5(15.6%) patients USG and MRI both demonstrated intrahepatic mass causing obstruction at the level of conuence of right and left hepatic duct or CHD. Ultrasonography was able to detect the intrinsic mass of the extrahepatic common bile duct in 2(6.2%) patients out of 32 patients in our study population. MRCP could detect the same in 6(18.7%) patients. In our study narrowing of CBD with stricture formation and upstream dilatation of biliary tree was identied in 10(31.2%) patients on MRCP. Ultrasound could diagnose the same in one patient. Both USG and MRCP were able to detect pancreatic head mass as well as pseudocyst. CONCLUSION: The accuracy of MRCP was found to be comparable to that of ERCP for diagnosis of etiology for obstructive jaundice. MRCP allows better lesion characterization and assessment. However, the patchy availability of MR machines become the main achilles heel for the surgeons as well as the radiologists. Hence the valuable role of the omnipresent ultrasonography become immense.

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Sphincter of Oddi Dysfunction: A Perplexing Presentation

Case Reports in Gastroenterology ◽

10.1159/000452736 ◽

2016 ◽

Vol 10 (3) ◽

pp. 714-719 ◽

Cited By ~ 3

Author(s):

Sana Ahmad Din ◽

Iman Naimi ◽

Mirza Beg

Keyword(s):

Abdominal Pain ◽

Magnetic Resonance Cholangiopancreatography ◽

Sphincter Of Oddi ◽

Abdominal Ultrasound ◽

Sphincter Of Oddi Dysfunction ◽

Sphincter Pressure ◽

Abdominal Symptoms ◽

Biliary Sphincterotomy ◽

Bile Drainage ◽

Oddi Dysfunction

Sphincter of Oddi dysfunction is caused by stenosis or dyskinesia of the sphincter of Oddi, leading to blockage of bile drainage from the common bile duct. We present the case of a 16-year-old female with chronic abdominal pain who underwent laparoscopic cholecystectomy for cholelithiasis but continued to experience abdominal pain, nausea, and vomiting along with persistently elevated ALT and AST levels. Postoperative abdominal ultrasound was nondiagnostic. Esophagogastroduodenoscopy showed mild reflux esophagitis and mild chronic Helicobacter pylori-negative gastritis. Omeprazole was started, but it did not decrease the frequency and severity of the abdominal symptoms. Magnetic resonance cholangiopancreatography did not reveal any pathology. Endoscopic retrograde cholangiopancreatography with manometry confirmed an elevated biliary sphincter pressure. Biliary sphincterotomy was performed, and the symptoms improved.

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DIAGNOSTIC FEATURES OF COMPLICATED CHOLELITHIASIS IN PREGNANT WOMEN

Kuban Scientific Medical Bulletin ◽

10.25207/1608-6228-2019-26-1-168-174 ◽

2019 ◽

Vol 26 (1) ◽

pp. 168-174

Author(s):

Karen D. Antinyan ◽

Evgenii S. Babenko ◽

Vladimir M. Durleshter

Keyword(s):

Pregnant Women ◽

Conflict Of Interest ◽

Magnetic Resonance Cholangiopancreatography ◽

Abdominal Ultrasound ◽

Perinatal Complications ◽

Laparoscopic Ultrasonography ◽

Endoscopic Retrograde ◽

Diagnostic Features ◽

Ultrasound Diagnostics ◽

Long Time

The aimis to describe modern approaches used in the diagnostics of cholelithiasis in pregnant women.Results.Cholelithiasis diagnostics in pregnant women is a rather difficult task, frequently taking a long time and significantly worsening the prognosis for both the mother and the fetus. Abdominal ultrasound is the “gold standard” for the diagnosis of cholelithiasis in pregnant women, allowing the diagnosis to be clarified and the treatment tactics to be adjusted. The possibilities of such modern methods as endoscopic ultrasound diagnostics, magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography, and laparoscopic ultrasonography used in difficult diagnostic cases are presented.Conclusion.The use of a maximal range of diagnostic studies in pregnant women makes it possible to establish the diagnosis as soon as possible and to reduce the frequency of surgical and related perinatal complications. As a result, the prolongation of pregnancy and a decrease in maternal and intrauterine mortality can be achieved.Conflict of interest: the authors declare no conflict of interest.

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