Type 1c choledochal cyst in a premature twin neonate: case report and literature review

CASE REPORTS

Type 1c Choledochal cyst in a premature twin neonate: Case report and literature review

Prashanth RR, Medha Goyal, Jyothi Sreekumari, Anitha Haribalakrishna.

Department of Neonatology, Seth G.S. Medical College and King Edward Memorial Hospital, Mumbai, India.

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Abstract
In this case report, we describe an uncommon presentation of choledochal cyst in a preterm infant, second of twins, born at 33+1 weeks by date, weighing 1434 g, born to an HCV positive mother. The anomaly was not identified in any antenatal ultrasound studies performed in any trimester. The clinical situation had presented us with a unique diagnostic dilemma with the first of the twins thriving well, in contrast to the second twin who developed unphysiological weight loss and neonatal cholestasis from day of life 23. Though the presentation was typically characteristic of an obstructive cause, this was overshadowed by premature status. There is a dearth of published literature regarding neonatal choledochal cyst, its presentation in preterm infants, and in twin babies.

Why this article important?

Choledochal cyst type 1c is to be considered in the differential of obstructive jaundice in a preterm neonate and requires early diagnosis with MRCP for better delineation of the biliary cyst subtype, pancreatic-biliary ductal anatomy and further surgical planning. Choledochal cyst being detected in preterm neonates is a rare cause of cholestatic jaundice and this neonate was symptomatic, deciding on surgery versus conservative management in a preterm neonate was difficult with limited literature on the same. In this twin pregnancy the other twin being normal and being exposed to the same internal milieu and genetics suggests that the risk of developing choledochal cyst is indeed variable and less predictable Ultrasound and MRCP interpretation of a choledochal cyst in a preterm neonate is extremely challenging and through this case report we highlight the work up for the same.

Summary of article

In this case report, we describe an uncommon presentation of choledochal cyst in a preterm infant, second of twins, born at 33+1 weeks by date, weighing 1434 g, born to an HCV positive mother. The anomaly was not identified in any antenatal ultrasound studies performed in any trimester. The clinical situation had presented us with a unique diagnostic dilemma with the first of the twins thriving well, in contrast to the second twin who developed unphysiological weight loss and neonatal cholestasis from day of life 23. Though the presentation was typically characteristic of an obstructive cause, this was overshadowed by premature status. There is a dearth of published literature regarding neonatal choledochal cyst, its presentation in preterm infants, and in twin babies.

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