Case presentation A 4-year-old girl came to a clinic with fever (for one week), altered sensorium, generalized abdominal pain, and distention. Medical history Since birth, she was hospitalized multiple times for repeated episodes of jaundice. Clinical investigation Blood tests: High bilirubin levels (17.4 mg/dl): Direct bilirubin 10.2 mg/dl & indirect bilirubin 7.2 mg/dl, elevated count of WBC: 15,900/mm3, extremely high levels of ammonia (129 mcg/dl) and serum galactose.
X-ray: Presence of inferior rib notching (chest frontal view) Echocardiogram: A juxtaductal coarctation of the aorta - Surgically corrected by an end-to-end anastomosis. Abdominal sonography revealed a vascular channel formed by the combination of the splenic and superior mesenteric veins, which coursed away from the gastro-hepatic ligament and opened into the intrahepatic inferior vena cava (IVC) (Figure 1). The…
