Biliary Dilatation While Awaiting Surgery for a Congenital Hiatal Hernia: A Case Report.

Giant congenital hiatal hernias that cause biliary dilatation are uncommon. We present the case of a female neonate with a massive hiatal hernia involving the entire stomach, which was located in the mediastinum, who developed cholestasis presenting with elevated bilirubin and grayish stools, along with dilatation of the intrahepatic and common hepatic ducts by 90 days of age. The common bile duct remained undilated and no pancreatic herniation was evident. A laparoscopic hernia repair was performed at 141 days. Intraoperative cholangiography suggested that hernia-induced common bile duct kinking caused the stasis; consequently, no biliary surgery was performed. Postoperatively, the liver function and bilirubin levels normalized, although MRI at 2 months revealed residual ductal dilatation. Neonatal hiatal hernias can induce biliary dilatation through mechanical kinking, even without pancreatic prolapse. While hernia repair may resolve cholestasis, persistent ductal alterations require long-term monitoring.