TY - JOUR T1 - Unexpected findings at laparotomy of a 12-year-old girl with obstructive jaundice and choledocholithiasis: a case report JF - World Journal of Pediatric Surgery JO - World Jnl Ped Surgery DO - 10.1136/wjps-2020-000201 VL - 4 IS - 3 SP - e000201 AU - Felix Oyania AU - Muriel Cleary AU - Alfred Ogwal AU - Arlene Muzira Nakanwagi AU - Nasser Kakembo AU - John Sekabira AU - Gustavo Villalona AU - Doruk Ozgediz Y1 - 2021/05/01 UR - http://wjps.bmj.com/content/4/3/e000201.abstract N2 - Congenital duodenal obstruction (CDO) is a relatively common neonatal anomaly with a reported incidence of 1 in 2500–10 000 live births.1 2 Diagnosis can be made prenatally with ultrasound (US) during antenatal care or during the postnatal period commonly as bilious vomiting and feeding intolerance. Patients with a partial stenosis can survive to present in a much-delayed fashion.3–6Annular pancreas (AP) is a rare congenital disorder that may be clinically asymptomatic, may present as a neonatal intestinal obstruction or as a more complex pathology in adults. The incidence is reported as 1–3 in 20 000. AP may be asymptomatic7 and discovered incidentally during routine investigations for other conditions or at autopsy. Most of the cases are diagnosed either prenatally or in the first few days of life.8 If the condition is neither diagnosed prenatally nor presents with complications in early life, it may be undetected until adulthood with varying complications, such as pancreatitis or gastric outlet obstruction, thereby making the diagnosis difficult. AP may coexist with other congenital anomalies.3 8–11 We report a case of obstructive jaundice from choledocholithiasis due to an AP that caused duodenal stenosis and biliary stasis.A 12-year-old girl who was referred from western Uganda presented with postprandial abdominal pain, food fear, progressive weight loss, jaundice and dark urine for 2 years. She reported often missing school due to abdominal pain. Initial US obtained by her local care providers showed dilated intrahepatic and extrahepatic ducts, a distended gall bladder and a stone in the common bile duct (CBD). The patient weighed only 32 kg and appeared wasted with moderate jaundice and scleral icterus during her physical exam. Her abdominal examination was unremarkable. Her initial laboratory workup showed mild anemia, no leukocytosis, significant hyperbilirubinemia with mildly elevated liver enzymes and a negative infectious workup … ER -