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Cholelithiasis in newborns and infants
D St-Vil1, S Yazbeck, F I Luks
1Department of Surgery, Ste-Justine Hospital, University of Montreal, Quebec, Canada.
Insights
Neonatal cholelithiasis (gallstones in infants) is more common than previously thought, often affecting males and typically resolving on its own. Aggressive treatment is usually unnecessary for asymptomatic infants.
Area of Science:
- Pediatrics
- Gastroenterology
- Medical Imaging
Background:
- Cholelithiasis (gallstones) in infants is rare, often linked to specific medical conditions.
- Increased use of abdominal ultrasonography (US) leads to more frequent diagnosis of infant gallstones.
Purpose of the Study:
- To report the experience with infant cholelithiasis diagnosed via abdominal US.
- To analyze the characteristics, predisposing factors, and outcomes of gallstones in infants.
Main Methods:
- Retrospective review of 13 infants diagnosed with gallstones using abdominal ultrasonography (US).
- Analysis of patient demographics, clinical presentation, presence of predisposing factors, and treatment outcomes.
Main Results:
- Nine boys and 4 girls diagnosed with gallstones, average age 2.6 months.
- Predisposing factors identified in only 6 of 13 infants.
- Five of ten asymptomatic infants showed spontaneous gallstone resolution; symptomatic infants required intervention.
Conclusions:
- Neonatal cholelithiasis is more common than previously suspected, affecting males more frequently.
- It is often idiopathic (without known predisposing factors) and appears to be self-limiting.
- Observation is recommended for asymptomatic infants; intervention reserved for symptomatic cases or those with lithogenic disorders.
Abstract:
Cholelithiasis in infants is rare, and has usually been associated with hemolysis, ileal disease, congenital anomalies of the biliary tree, hyperalimentation, and prolonged fasting. With the increased use of abdominal ultrasonography (US), more cases of cholelithiasis are being discovered. We report our experience with 13 infants diagnosed on abdominal US to have gallstones. There were 9 boys and 4 girls with an average age at diagnosis of 2.6 months (range, 0 to 9 months). Predisposing factors could be identified in only 6 of the 13 patients. Two patients with obstructive jaundice underwent cholecystectomy and common bile duct exploration. One patient with choledocolithiasis and common bile duct dilatation was observed. His stone passed spontaneously, with resolution of symptoms. Ten patients without cholestasis remained asymptomatic, with disappearance of lithiasis in five of them. Neonatal cholelithiasis is more common than previously suspected; it seems to affect males more often than females and is usually not associated with known predisposing factors. It appears to be a temporary, self-limiting phenomenon, and an aggressive approach is not warranted in the asymptomatic infant. Surgical or radiological intervention should be reserved for the symptomatic patients or those with underlying lithogenic disorders.