Congenital duodenal obstruction (CDO) is a relatively common neonatal anomaly with a reported incidence of 1 in 2500–10 000 live births.1 2 Diagnosis can be made prenatally with ultrasound (US) during antenatal care or during the postnatal period commonly as bilious vomiting and feeding intolerance. Patients with a partial stenosis can survive to present in a much-delayed fashion.3–6 Annular pancreas (AP) is a rare congenital disorder that may be clinically asymptomatic, may present as a neonatal intestinal obstruction or as a more complex pathology in adults. The incidence is reported as 1–3 in 20 000. AP may be asymptomatic7 and discovered incidentally during routine investigations for other conditions or at autopsy. Most of the cases are diagnosed either prenatally or in the first few days of life.8 If the condition is neither diagnosed prenatally nor presents with complications in early life, it may be undetected until adulthood with varying complications, such as pancreatitis or gastric outlet obstruction, thereby making the diagnosis difficult. AP may coexist with other congenital anomalies.3 8–11 We report a case of obstructive jaundice from choledocholithiasis due to an AP that caused duodenal stenosis and biliary stasis. A 12-year-old girl who was referred from western Uganda presented with postprandial abdominal pain, food fear, progressive weight loss, jaundice and dark urine for 2 years. She reported often missing school due to abdominal pain. Initial US obtained by her local care providers showed dilated intrahepatic and extrahepatic ducts, a distended gall bladder and a stone in the common bile duct (CBD). The patient weighed only 32 kg and appeared wasted with moderate jaundice and scleral icterus during her physical exam. Her abdominal examination was unremarkable. Her initial laboratory workup showed mild anemia, no leukocytosis, significant hyperbilirubinemia with mildly elevated liver enzymes and a negative infectious workup …

中文翻译：

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一名患有梗阻性黄疸和胆总管结石的 12 岁女孩剖腹手术的意外发现：病例报告

先天性十二指肠梗阻 (CDO) 是一种相对常见的新生儿异常，据报道每 2500–10 000 名活产中就有 1 例发生。 12 可以在产前检查期间通过超声 (US) 进行产前诊断，或者在产后通常表现为胆汁性呕吐和喂养不耐受。部分狭窄的患者可以存活到出现的时间很晚。 3-6 环状胰腺 (AP) 是一种罕见的先天性疾病，可能没有临床症状，可能表现为新生儿肠梗阻或成人更复杂的病理. 发病率报告为每 20 000 人中有 1-3 人发生。AP 可能没有症状 7 并且在对其他情况进行常规调查或尸检时偶然发现。大多数病例是在产前或出生后最初几天被诊断出来的。8 如果这种情况既没有在产前诊断出来，也没有在生命早期出现并发症，则可能直到成年才被发现，并伴有各种并发症，例如胰腺炎或胃出口梗阻，从而使诊断变得困难。AP 可能与其他先天性异常共存。3 8-11 我们报告了一例因 AP 导致十二指肠狭窄和胆道淤滞而导致的胆总管结石引起的梗阻性黄疸。一名来自乌干达西部的 12 岁女孩因餐后腹痛、食物恐惧、进行性体重减轻、黄疸和尿色深 2 年就诊。她经常因为腹痛而缺课。她的当地护理人员获得的初步超声显示肝内和肝外导管扩张、胆囊扩张和胆总管 (CBD) 结石。患者体重仅 32 公斤，在体检期间出现消瘦并伴有中度黄疸和巩膜黄染。她的腹部检查没有异常。她最初的实验室检查显示轻度贫血、无白细胞增多、明显的高胆红素血症伴肝酶轻度升高以及感染性检查阴性……