Benign papillomatosis of common bile duct in children: A rare case report
Our case was a 3-year-old female child who presented to our pediatric surgical outpatient department with complaints of pain in the upper part of the abdomen along with jaundice and fever for last 6 months. On per abdominal examination no lump or hepatosplenomegaly was found. With the clinical possibility of a choledochal cyst, ultrasonography (USG) along with liver function test and routine hematological investigations were advised. USG showed impacted worm-like appearance in the lower common bile duct (CBD) with proximal dilatation []. Choledochal cyst was ruled out. In view of the deepening jaundice, child was advised endoscopic retrograde cholangiopancreatography (ERCP) to clear the worm load in the lower end of CBD and to place the stent for establishing the bile flow. Thus, endoscopic sphincterotomy with placement of 10 Fr stent was done []. There were no worms in the CBD in this patient. The child also received anthelmintics. Following stent placement child recovered from jaundice within 2 weeks. As there was a doubt of persistent worm in the distal CBD, exploration was planned; and after obtaining informed written consent, the child was explored under general anesthesia. Right upper transverse incision was given, abdominal cavity was opened, liver mobilized, gall bladder identified, and CBD traced using stent as a guide. On opening the CBD multiple polyps were found with stent in situ [] without stone or worm. In view of possible malignancy a frozen section was sent and when confirmed to be benign, polyps were removed completely along with stent and CBD was repaired over a T-tube. Postoperatively T-tube was removed after 3 weeks. The child recovered uneventfully and presently she is in close follow-up and doing well. Specimen sent for histopathological examination showed adenomatous polyps with colonic metaplasia.