2020 Volume 56 Issue 7 Pages 1161-1166
A 30-day-old female infant was admitted to our hospital with symptoms including persistent jaundice and heart failure caused by patent ductus arteriosus (PDA). She was delivered at a gestational age of 37 weeks and 4 days with a birth weight of 2,160 g. No abnormalities were detected on fetal ultrasonography at the gestational age of 28 weeks. Physical examination showed jaundice and blood examination showed elevated levels of biliary enzymes. Abdominal ultrasonography revealed a cystically dilated common bile duct without dilatation of the intrahepatic bile duct. In addition, a large protein plug 18 mm in diameter was found in the cyst. Congenital biliary dilatation (Todani type Ia) with a protein plug was diagnosed. Nine days after admission, the patient underwent PDA ligation; after which, her jaundice worsened. To treat the jaundice and dissolve the protein plug, ursodeoxycholic acid and bromhexine hydrochloride were administered. A radical operation was performed at 75 days of age (weight: 3,300 g). Intraoperative cholangiography showed pancreaticobiliary maljunction and that the common duct measured 12 mm. There was no protein plug in the cyst. These findings suggest that bromhexine hydrochloride is effective for preoperative management and dissolving protein plugs in neonatal cases with congenital biliary dilatation.
