Intrapancreatic common bile duct duplication presenting with choledocholithiasis in a toddler: a case report
Bibliographic record
Abstract
Common bile duct (CBD) duplication is an extremely rare congenital anomaly, with most cases reported in adults.Only 14 cases have been reported in children A previously healthy 14-month-old girl (8.3 kg) presented with intermittent fevers and diarrhea. There was no history of abdominal pain, jaundice, weight loss, or anorexia. Physical examination was unremarkable. Liver function tests (LFTs) were elevatedelevated (aspartate aminotransferase (AST) 562 U/L, alanine transaminase (ALT) 540 U/L, gamma-glutamyl transferase (GGT) 678 U/L) except for a normal bilirubin. An abdominal ultrasound revealed a both dilated intrahepatic and extrahepatic bile ducts.A magnetic resonance cholangiopancreatography (MRCP) demonstrated an intrapancreatic CBD duplication and multiple choledocholithiasis. An endoscopic retrograde cholangiopancreatography (ERCP) was attempted but failed as the endoscope could not pass the child’s pylorus. A percutaneous transhepatic cholangiogram confirmed the patient’s anatomy and successfully removed the choledocholithiasis. An external-internal biliary drain was placed due to extensive biliary manipulations, and intravenous antibiotics were administered. One week later, definitive surgical management was performed; the patient underwent a laparoscopic CBD resection with a Roux-en-Y hepaticojejunostomy. The postoperative course was unremarkable, and she was discharged on postoperative day 4. One year after surgery, she is doing well with normal LFTs and no recurrence of choledocholithiasis. Even though they are rare, duplications of the common bile duct should be included in the differential diagnosis of children who develop abdominal pain and have dilatation of the intrahepatic and/or extrahepatic biliary tree.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".