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Porta hepatis lymphnode mimicking biliary atresia: A case report
Elisamia Ngowi1, Juliana Kwayu2, Abduel Kitua3
1Department of Paediatrics and Child Health, Aga Khan Hospital Tanzania, P.O. Box 2289, Dar Es Salaam, Tanzania; Department of Paediatrics and Child Health, Aga Khan University, P.O. Box 38129, Dar Es Salaam, Tanzania.
Insights
A rare case of infant jaundice highlights that while biliary atresia is common, enlarged lymph nodes can also obstruct bile flow, necessitating broader diagnostic considerations for neonatal cholestasis.
Area of Science:
- Pediatric Gastroenterology
- Neonatal Medicine
- Surgical Pathology
Background:
- Cholestasis, characterized by impaired bile flow, leads to jaundice and can cause irreversible organ damage if untreated.
- Jaundice beyond two weeks in neonates is uncommon, with biliary atresia being the most frequent cause of extrahepatic obstruction.
- Early diagnosis and intervention are critical for managing cholestasis and preventing severe complications.
Introduction:
Cholestasis is the impairment of normal bile flow causing accumulation of bile salts, lipids, and bilirubin in blood which presents as Jaundice. Jaundice beyond 2 weeks of age is rare in infancy with worldwide incidence of 1 in 2500 live births. Biliary atresia is the most common extra hepatic cause of cholestasis in late neonatal and infancy period. Cholestasis and hyperbilirubinemia cause irreversible brain and liver damage if not diagnosed and treated early.
Case Presentation:
A 3-week-old neonate presenting with progressive yellowish discoloration of eyes and skin. Explorative laparotomy found anatomically normal liver and biliary tree, but a lymph node obstructing the common bile duct.
Discussion:
This case was particularly unique as history of illness and initial investigations were suggestive of biliary atresia. However, the patient had lymph nodes with no history of any triggers to lymphadenopathy. It is a rare case of obstruction of biliary flow in this age group.
Conclusion:
Despite biliary atresia being the commonest cause of obstructive jaundice in infancy, it is important to rule out other causes like lymph nodes obstructing the biliary tree.
