Murillo Juan Miguel L, Gregorio Germana Emerita V
Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, College of Medicine and Philippine General Hospital, University of the Philippines Manila.
Acta Med Philipp. 2024 Aug 15;58(14):99-104. doi: 10.47895/amp.vi0.8017. eCollection 2024.
Jaundice in older children can occur when any obstruction is found within the bile ducts, either from bile stones, parasites, choledochal cysts and rarely, secondary to tumors. We present a previously well, 10-year-old Filipino boy with three-week history of progressive jaundice and tea-colored urine, and was initially assessed to have biliary ascariasis. Ultrasound showed a heterogeneous focus spanning the gallbladder neck and confirmed on endoscopic retrograde cholangiopancreatography as an exophytic mass at the ampulla of Vater. Tumor biopsy and immunohistochemical staining confirmed the diagnosis of Embryonal Rhabdomyosarcoma of the Bile Ducts. Chemotherapy was initiated to reduce the size of the tumor before any surgical intervention could be attempted. Despite chemotherapy, the tumor progressively grew. He acquired a respiratory infection which led to sepsis and his eventual demise. The disease should be considered in the differential diagnosis of a child with obstructive jaundice after exclusion of other more common causes.
大龄儿童黄疸可能在胆管出现任何梗阻时发生，梗阻原因包括胆结石、寄生虫、胆总管囊肿，极少数情况下继发于肿瘤。我们报告一名既往健康的10岁菲律宾男孩，有三周进行性黄疸和茶色尿病史，最初评估为胆道蛔虫病。超声显示一个跨越胆囊颈部的不均匀病灶，经内镜逆行胰胆管造影证实为十二指肠乳头外生性肿块。肿瘤活检及免疫组化染色确诊为胆管胚胎性横纹肌肉瘤。在尝试任何手术干预之前，先进行化疗以缩小肿瘤大小。尽管进行了化疗，肿瘤仍逐渐生长。他患上了呼吸道感染，导致败血症，最终死亡。在排除其他更常见原因后，对于患有梗阻性黄疸的儿童进行鉴别诊断时应考虑这种疾病。
