Porta hepatis lymphnode mimicking biliary atresia: A case report

TL;DR

A 3-week-old infant with jaundice was found to have a lymph node blocking bile flow, mimicking biliary atresia, highlighting the need for careful diagnosis.

Contribution

This case report highlights a rare instance where an intrahepatic lymph node mimicked biliary atresia in an infant.

Findings

A lymph node was found to obstruct the common bile duct in a neonate with cholestatic jaundice.

The case emphasizes the importance of biopsies to avoid unnecessary surgery in diagnosing cholestatic jaundice.

Intrahepatic lymph nodes can present similarly to biliary atresia in infants.

Abstract

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.

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.

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.

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.

•Cholestatic jaundice is rare in infancy and biliary atresia should be ruled out promptly as the most common cause.•It is important to do biopsy before exploratory laparotomy to minimize unnecessary surgical procedures.•Intrahepatic lymph node can mimic biliary atresia.

Cholestatic jaundice is rare in infancy and biliary atresia should be ruled out promptly as the most common cause.

It is important to do biopsy before exploratory laparotomy to minimize unnecessary surgical procedures.

Intrahepatic lymph node can mimic biliary atresia.

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