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Case No. 05 - Answer

Answer:

Diagnosis: Bile plug syndrome

D.D: Biliary rhabdomyosarcoma

       : Sludge in a dilated CBD ( choledochal cyst)

       : Worm infestation ( less common for this age)

 

What would you like to do next?

  • Meticulous history- taking regarding delayed passage of meconium in perinatal period (index case: passage of meconium of 10th day of life; and was a patient of cystic fibrosis)

  • MRCP with contrast ( in case of suspected rhabdomyosarcoma)

 

Bile plug syndrome ( Inspissated bile syndrome)

  1. It is defined as obstruction of the extrahepatic bile ducts by bile sludge in term infants without anatomic abnormalities of the biliary tract or hepatocellular lesions

  2. Risk factors

  • Acute dehydration

  • Sepsis

  • Cystic fibrosis

  • Parenteral nutrition

  • Hemolytic diseases

  • Starvation

  • Prematurity

  • Diuretic treatment

  • USG: Dilatation of the biliary tree with echogenic sludge within dilated ducts; no vascularity within intraductal lesion on Doppler interrogation

  • Treatment

  • Percutaneous trans-hepatic cholangiogram with single shot saline lavage

  • US-guided percutaneous cholecystostomy drain insertion and ongoing irrigation of the biliary system

Correct Answer Submitted by:

 

  1. R Praveen Kesav

  2. Richa Yadav

  3. Kushal Gehlot

  4. Anuradha dawani

  5. Nothish Pravin

  6. Mayoukh Sarkar

  7. Madhuri Kumari

  8. Taruna Yadav

  9. Atula Jain

  10. Shameema Farook

  11. Narasimman Murugan

  12. Geetika Bansal Tuli