Clin Endosc.  2014 Mar;47(2):201-204. 10.5946/ce.2014.47.2.201.

A Case of Choledocholithiasis and Intestinal Malrotation in an Adolescent with Repaired Gastroschisis

• Kim BC
• Kim KB
• Kim EJ
• Park S
• Lee DH
• Kim EB
• Chae HB
• Park SM

• KMID: 2049011
• DOI: http://doi.org/10.5946/ce.2014.47.2.201

Abstract

Most infants with repaired gastroschisis develop normally and remain in good health. About 10% of patients with gastroschisis have other malformations. We report a case of choledocholithiasis and intestinal malrotation in an adolescent with repaired gastroschisis. A 17-year-old girl presented with fever, jaundice, and abdominal pain. She had undergone an operation to repair gastroschisis at birth. Physical examination revealed icteric sclera, a tight abdominal wall, and a longitudinal surgical scar at the midline. An abdominal computed tomography scan revealed a round calcifying lesion near the pancreas and a midline-positioned liver and gallbladder. Absence of the retroperitoneal duodenum and the anterior and left-sided position of the superior mesenteric vein compared with the superior mesenteric artery were observed. Results of abarium examination revealed intestinal malrotation. Endoscopic retrograde cholangiopancreatography revealed diffuse dilatation of the biliary trees and a malpositioned gallbladder. A single stone was removed by using a basket. The clinical symptoms improved after the patient underwent endoscopic retrograde cholangiopancreatography.

Keyword

Gastroschisis; Intestinal malrotation; Choledocholithiasis

MeSH Terms

Abdominal Pain
Abdominal Wall
Adolescent*
Cholangiopancreatography, Endoscopic Retrograde
Choledocholithiasis*
Cicatrix
Dilatation
Duodenum
Female
Fever
Gallbladder
Gastroschisis*
Humans
Infant
Jaundice
Liver
Mesenteric Artery, Superior
Mesenteric Veins
Pancreas
Parturition
Physical Examination
Sclera

Figure

• 

  Fig. 1 Abdominal computed tomography findings. (A) A pre-enhanced computed tomography scan revealed a round calcifying lesion near the pancreas (arrow). (B) The absence of the retroperitoneal duodenum and the anterior and left-sided position of the superior mesenteric vein (arrowhead) compared with that of the superior mesenteric artery (arrow) were identified. (C) Coronal view showing the distorted architecture of the liver (arrows) and a high-attenuation lesion at the extrahepatic bile duct (arrowhead).

• 

  Fig. 2 A barium meal examination revealed a right-sided duodenojejunal flexure and malpositioning of the bowel, with the small bowel on the right side (arrows) and the colon on the left side (arrowheads).

• 

  Fig. 3 Cholangiography. (A) With a guidewire-assisted technique, the single stone was removed by using a Dormia basket. (B) Diffuse dilatation of the intrahepatic and extrahepatic biliary trees and a downward-positioned gallbladder (arrows). The abnormal orientation of the duodenum (arrowhead) suggested intestinal malrotation. (C) Distorted architecture of the biliary tree.

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