Obstructive Jaundice Caused by Hepatic Torsion in an Infant
Most babies with congenital diaphragmatic hernia (CDH) are now diagnosed on antenatal ultrasound, however, they may present with respiratory distress after birth. Delayed presentation is also seen if the baby has normal respiratory reserves. Right diaphragmatic hernia with persistent jaundice beyond the newborn period is not common.[1,2] We present a rare case of right diaphragmatic hernia with hepatic torsion causing biliary obstruction and obstructive jaundice. To our knowledge, this anomaly has not been reported in the available literature.

Case Report
A 2-month-old baby girl was referred with jaundice, acholic stool, and highly colored urine since birth. She was admitted to another hospital with fever, cough and poor intake and treated as a case of pneumonia, right diaphragmatic hernia, and cholestatic jaundice. She was referred to us for further evaluation of jaundice. On admission, the baby was moderately jaundiced but had stable vitals. There were decreased breath sounds on the right basal zone. Abdominal examination revealed palpable liver and normal bowel sounds. Rest of systemic examination was unremarkable. The total bilirubin was 12.50 mg/dl, alanine transaminase 244 U/L, aspartate transaminase 500 U/L, alkaline phosphatase 485 U/L, and albumin 3.2 g/dl. X-ray revealed marked elevation of the right dome of the diaphragm with upward migration of the liver. Ultrasound, computed tomography abdomen and magnetic resonance (MR) cholangiogram showed CDH with a large segment of the liver herniated into the right chest and severe intra and extrahepatic bile duct dilatation....