Rare Cause of Obstructive Jaundice in a Young Female

Abstract

Introduction: Congenital common bile duct (CBD) webs are extremely rare abnormalities of the extra hepatic ducts with approximately 10 cases reported in the literature. The age at presentation and the clinical symptomatology of these anomalies depend on the grade of the biliary obstruction. These webs usually exhibit early in life as obstructive jaundice, dilation of the proximal biliary tree or even spontaneous perforation of the extra hepatic duct. Some of these congenital webs are partially developed and remain asymptomatic until adulthood. Case Report: 28 year female patient presented with cholestatic pattern jaundice for 2 months. On evaluation found to have dilated CBD with IHBRD on USG. On further imaging studies, CT revealed horizontal web like projection from distal CBD suggestive of web with similar findings on MRCP. ERCP showed horizontal filling defect on cholangiogram with dilated CBD. Endoscopic Ultrasound examination revealed horizontal hyper echoic structure at distal CBD with proximally dilated CBD and IHBRD. Dilatation was performed using Soehendra Biliary Dilation Catheter with significant improvement in her symptomatology. Conclusion: Our case remains the first of its kind in which EUS characterisation of CBD web is described. Though rare congenital anomalies remain an important cause of young patients presenting with obstructive jaundice. Treatment for such cases remains Endoscopic dilatation or surgical by-pass in which endoscopic treatment fails. Keywords: Common bile duct web; Obstructive jaundice; Soehendra Biliary Dilation Catheter; Endoscopic Ultrasound. Abbreviations: HB-Haemoglobin; TLC-Total Leucocyte Count; AST-Aspartate Transaminase; ALT-Alanine Transaminase; ALPAlkaline Phosphatase; USG- Ultrasonography; IHBRD- Intra-hepatic biliary radicle, CBD- Common bile duct; GB- Gall bladder; MRCPMagnetic Resonance Cholangio-Pancreatography