An unusual cause of obstructive jaundice; computed tomography and ultrasound findings of duodenal non-Hodgkin's lymphoma

In children, non-Hodgkin's lymphoma (NHL) is an uncommon cause of obstructive jaundice [Watanabe Y, Ito T, Horibe K, et al. Obstructive jaundice, an unusual initial manifestation of intraabdominal non-Hodgkin's lymphoma in children: complications of percutaneous transhepatic cholangial drainage. J Pediatr Surg 1997;32(4):650–3; Pietsch JB, Shankar S, Ford C, Johnson JE. Obstructive jaundice secondary to lymphoma in childhood. J Pediatr Surg 2001;36(12):1792–5; Ravindra K, Stringer M, Prasad K, Kinsey S, Lodge J. Non-Hodgkin's lymphoma presenting with obstructive jaundice. Br J Surg 2003;90:845–9; Hsu CF, Ko SF, Hsiao CC, Shieh CS, Huang CC, Huang FC. Obstructive jaundice as the presenting manifestation of Burkitt's lymphoma in a 4-year-old boy. J Formos Med Assoc 2003;102(2):105–8], which is usually a late manifestation of NHL [Hsu CF, Ko SF, Hsiao CC, Shieh CS, Huang CC, Huang FC. Obstructive jaundice as the presenting manifestation of Burkitt's lymphoma in a 4-year-old boy. J Formos Med Assoc 2003;102(2):105–8]. Rarely, the primary symptom of NHL is obstructive jaundice caused by pancreaticobiliary obstruction from an abdominal mass [Watanabe Y, Ito T, Horibe K, et al. Obstructive jaundice, an unusual initial manifestation of intraabdominal non-Hodgkin's lymphoma in children: complications of percutaneous transhepatic cholangial drainage. J Pediatr Surg 1997;32(4):650–3; Pietsch JB, Shankar S, Ford C, Johnson JE. Obstructive jaundice secondary to lymphoma in childhood. J Pediatr Surg 2001;36(12):1792–5; Colebath JH. Tumors of liver and bile ducts. In: Jones PG, Campbell PE, editors. Tumors of infancy and childhood. Oxford: New York, NY; 1976. p. 596–626]. Usually enlarged hilar or peripancreatic lymph nodes cause such obstructions [Ravindra K, Stringer M, Prasad K, Kinsey S, Lodge J. Non-Hodgkin's lymphoma presenting with obstructive jaundice. Br J Surg 2003;90:845–9]. There are very few reports of pancreaticobiliary obstruction caused by NHL of the small intestine and duodenum [Pietsch JB, Shankar S, Ford C, Johnson JE. Obstructive jaundice secondary to lymphoma in childhood. J Pediatr Surg 2001;36(12):1792–5]. In this report, we describe obstructive jaundice resulting from the external compression of the pancreaticobiliary duct caused by duodenal NHL in a 4-year-old girl.