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The spectrum of cholelithiasis in the first year of life
W J Schirmer1, E R Grisoni, M W Gauderer
1Division of Pediatric Surgery, Rainbow Babies and Children's Hospital, Cleveland, OH.
Insights
Pediatric cholelithiasis (gallstones) is increasingly diagnosed in infants. This study found varied presentations and outcomes, highlighting uncertainties in causes and management for infant gallstones.
Area of Science:
- Pediatrics
- Gastroenterology
- Neonatology
Background:
- Cholelithiasis (gallstones) is increasingly diagnosed in pediatric populations.
- Infant gallstones, particularly in those under one year, represent a growing clinical concern.
Purpose of the Study:
- To investigate the clinical characteristics, predisposing factors, and outcomes of cholelithiasis diagnosed in infants.
- To understand the natural history and management challenges of pediatric gallstones.
Main Methods:
- Retrospective review of 12 patients diagnosed with cholelithiasis before age 1 year over a 5-year period.
- Analysis of medical records for predisposing factors, clinical presentation, interventions, and follow-up outcomes.
Main Results:
- Diagnosis ranged from in utero (7th gestational month) to before 1 year of age.
- Eight patients received central parenteral nutrition; four had no identifiable risk factors.
- Presentations included infectious complications (3), elective cholecystectomy (2), spontaneous resolution (3), and asymptomatic cases (4).
Conclusions:
- Infantile cholelithiasis presents diversely, with some cases lacking clear predisposing factors.
- The natural history and optimal treatment strategies for pediatric gallstones remain uncertain, necessitating further research.
Abstract:
Cholelithiasis is being diagnosed with increased frequency in the very young. We encountered 12 patients over a 5-year period in whom cholelithiasis was diagnosed prior to age 1 year. The earliest diagnosis was made in utero during the seventh gestational month. While most of the children suffered from complex medical disorders, 4 of the 12 had no recognizable predisposing factors. Eight of the 12 were treated at some point prior to diagnosis with central parenteral nutrition. Three presented with infectious complications requiring prompt operative intervention. Two children underwent elective cholecystectomy nearly 2 years after the diagnosis for symptoms of biliary colic. Of the remaining seven, spontaneous stone resolution was documented in three, while four remain asymptomatic after a minimum of years follow-up. The spectrum of presentations in this series highlights the uncertainties regarding the etiology, natural history, and treatment of this increasingly more common disorder.
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