Abstract
Hemangioma is a rare cause of hepatobiliary obstruction in children. We report a child with obstructive jaundice caused by capillary hemangioma.
A 2-year-old boy was referred to our institution because of jaundice and acholic stool. There was absence of hepatomegaly or palpable mass on physical examination. Results of laboratory studies were as follows: total bilirubin, 8.7 mg/dl; direct bilirubin, 6.3 mg/dl; AST 271 IU/l; ALT 303 IU/l; CRP 0.2 mg/dl. Magnetic resonance imaging and ultrasonography showed severe stenosis of the common hepatic duct (CHD) and dilation of the intrahepatic and both hepatic ducts. Tumor markers were within the normal limits.
An exploratory laparotomy was performed because jaundice was developing rapidly. Intraoperative cholangiography via the gallbladder revealed complete stenosis of the common hepatic duct with normal choledochus. On palpation, there was partial thickening of the wall in the CHD with reference to the site of the stenosis. No patency was observed in the stenotic site after choledochotomy at the confluence of three ducts. A biopsy specimen was obtained from the thickened wall, and a drainage tube was threaded through the biopsy site because outflow of bile was observed at the site. Jaundice rapidly disappeared with improvement of liver function. A histopathological study showed benign hyperplastic lesions without malignancy and inflammation.
As repeated cholangiography through the drainage tube revealed no improvement of the CHD obstruction, we resected the extrahepatic biliary tract with reconstruction of hepaticojejunostomy 2 months thereafter. A histiopathological diagnosis of juvenile capillary hemangioma of the CDH was confirmed. He is curently doing well without jaundice 5 years after the operation.
