Cholangitis and choledocholithiasis after repair of duodenal atresia: a case report

Cholelithiasis is a rare but known complication of surgery for duodenal atresia. Occurrence of choledocholithiasis as sequelae of duodenoduodenostomy is still rarer. Biliary stasis resulting from compression of common bile duct due to periductal fibrosis may predispose to gallstone formation. We are reporting a case of choledocholithiasis in a 6 year old child as a late post-operative complication of duodenoduodenostomy [for duodenal atresia in the neonatal period]. To the best of our knowledge this is the first case of its kind reported in English literature. Cholecystectomy followed by choledocholithotomy was done and the patient had an uneventful recovery. Upper abdominal pain in any patient with a history of surgery for duodenal atresia in the past warrants a thorough evaluation for any biliary tract anomaly, cholecystitis, cholangitis, cholelithiasis or choledocholithiasis

Chronic abdominal pain in a child

A 6-year-old boy presented to our out patients department with recurrent lower abdominal pain. Pain was started 2 years before intermittently, but it worsened over the past 6 months. Pain aggravated after eating meals. Patient's parent also gave a history of episodes of abdominal distension and constipation. Other symptoms, as well as his past history and family history, were otherwise unremarkable. Physical examination revealed a slightly distended abdomen. There was a huge intra-abdominal mass occupying the center of the abdomen. It was a single mass, freely mobile, firm in consistency, smooth surfaced with well defined margins, and nonballotable. Routine blood tests, including renal function and urine analysis, were normal. Computed tomography of the abdomen and pelvis revealed a huge heterogeneous mass extending from epigastrium to pelvis [Figure 1]. The entire small bowel loop was displaced laterally by the mass. There was no lymphadenopathy, and invasion of mass into the adjacent organ