Neonatal bile duct stricture associated with maternal ketamine use: a case report

Introduction: Ketamine is a widely used intravenous dissociative anaesthetic and analgesic agent with a high safety profile. Increasingly, it is being used as a recreational drug for its hallucinogenic properties. Chronic use of ketamine has been increasingly associated with a number of bladder-related and hepatobiliary complications in adults.We present what we believe to be the first case of a bile duct stricture occurring in a neonate which was linked to maternal ketamine abuse. Case presentation: A male, term infant (birth weight – 4.9 Kg) presented with short history of pale stools, dark urine, and conjugated jaundice.He had required a brief admission to a neonatal intensive care for abstinence syndrome. Maternal urine testing during pregnancy had been positive for both ketamine and opioids. Clinical examination was unremarkable apart from jaundice and bilateral sensorineural hearing loss. Laboratory studies showed hyperbilirubinemia (127 μmol/L, conjugated 89 μmol/L), raised AST (208 U/L) and GGT (964 U/L), and thrombocytosis (platelet count 659 × 109/L). Viral serology, metabolic and genetic screening were negative. An MRCP showed dilatation of the extrahepatic biliary tract with abrupt narrowing at the level of the distal common bile duct (CBD). Laparotomy at 90 days confirmed a distal bile duct stricture. The patient underwent cholecystectomy, distal bile duct resection, and hepaticojejunostomy. Postoperatively, he recovered uneventfully with normalization of stool colour and early clearance of his jaundice. Histopathology confirmed ductal fibrosis, epithelial denudation, and mild portal fibrosis in the liver. He remains well on follow-up. Conclusion: This case is highly suggestive of transplacental maternal ketamine abuse causing biliary damage and stricture.