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Clinical management of infantile cholelithiasis
Cerine Jeanty1, S Christopher Derderian1, Jesse Courtier2
1Department of Surgery, University of California, San Francisco (UCSF), San Francisco, CA.
Insights
Infantile cholelithiasis, a rare condition in infants, often presents with risk factors like TPN and sepsis. Management varies, with conservative approaches showing success in selected cases.
Area of Science:
- Pediatrics
- Gastroenterology
- Neonatology
Background:
- Infantile cholelithiasis is a rare condition with poorly defined management strategies.
- Identifying risk factors and complications is crucial for effective treatment.
Purpose of the Study:
- To examine risk factors, complications, and management of infantile cholelithiasis.
- To evaluate outcomes of different treatment modalities in infants.
Main Methods:
- Retrospective review of infants diagnosed with cholelithiasis via ultrasound (1997-2013).
- Analysis of patient history, presentation, imaging, labs, and treatment.
- Categorization of risk factors, symptoms, and complications.
Main Results:
- 50 infants evaluated; 74% had risk factors (TPN, diuretics, antibiotics, sepsis, CHD, prematurity, malabsorption).
- 13% were symptomatic (emesis, jaundice); complications included choledocholithiasis (9), cholecystitis (3), pancreatitis (1).
- Nearly half of complicated cases had congenital heart disease (CHD); 25% conservative management resolution.
Conclusions:
- Infantile cholelithiasis outcomes vary, from spontaneous resolution to severe complications.
- Conservative management (ERCP, medical) is a viable alternative to surgery, especially in high-risk infants.
- Proper patient selection is key for successful non-operative treatment of gallstones in infants.
Purpose:
Infantile cholelithiasis is a rare disease process, and management strategies are poorly defined. We therefore examined the risk factors, complications, and management of this disease at our institution.
Methods:
We retrospectively reviewed infants with cholelithiasis diagnosed on ultrasound between 1997 and 2013. Details of the patient's medical history, presentation, imaging findings, laboratory values, and treatment were reviewed and analyzed.
Results:
Over the 16-year period, 50 infants were evaluated for cholelithiasis. Thirty-seven (74%) had at least one risk factor for gallstone development which included total parenteral nutrition, diuretic therapy, cephalosporin antibiotic treatment, sepsis, congenital heart disease (CHD), prematurity, or a malabsorptive gastrointestinal condition. Thirteen (26%) infants were symptomatic, most commonly presenting with emesis and jaundice. Complications from gallstones included choledocholithiasis (9), cholecystitis (3), and pancreatitis (1). Nearly half (6/13) of patients with complicated cholelithiasis had CHD. Of infants presenting with complications, 9 had a cholecystectomy, most commonly via a laparoscopic approach, 2 had an ERCP for choledocholithiasis, and 2 were medically managed. In patients managed conservatively, resolution of gallstones occurred in 25%.
Conclusions:
Infantile cholelithiasis has variable outcomes ranging from spontaneous resolution to choledocholithiasis or cholecystitis. While patients with complicated cholelithiasis often undergo an operation, infants <1year of age have higher anesthetic and surgical risks. Conservative management with ERCP or medical treatment can also be successful, which offers an alternative to operative intervention in properly selected patients.
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