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A 14-year-old patient with jaundice and distal CBD obstruction
  • Patient presented with jaundice for 1.5 month. associated with dark colour urine, wt loss no nausea or vomiting, no fever.
  • Patient had dermatological disease since childhood.
  • Her investigation was T.S.B=9.9mg/dl, direct 7.7, alkaline phosphatase=540 IU/L.
  • Virology screen was negative.
  • CBC was normal.
  • ESR=22.
  • OGD not been done because she had chest infection and unfit for G.A.
  • U/S shown liver enlarged in size, fatty texture, smooth outline .dilated intra and extra hepatic biliary tree, dilated CBD=12mm dilated to its most distal end, no stone.
  • GB grossly dilated with normal wall thickness, no stone.
  • Spleen enlarged in size = 19 cm ,with normal texture.
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