Porta hepatis lymphnode mimicking biliary atresia: A case report

Abstract

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.

Keywords: Biliary atresia; Case report; Cholestatic jaundice; Unconjugated hyperbilirubinemia.

Fig. 1

Ultrasound images on admission.

Fig. 2

Abdominal ultrasound images 1-week post-surgery.

Fig. 3

A dynamic HIDA SCAN study was acquired for 60 min, and static images were obtained at 1 h and 24 h. There was good hepatocellular function with features in keeping with Biliary Atresia.

Fig. 4

Slides of liver tissue.

Fig. 5

Histopathological images from lymph nodes.

Fig. 6

Intra operative image showing a biliary tree, part of the liver and surrounding structures.