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Radiological treatment of common bile duct lithiasis in infancy
D Pariente1, O Bernard, F Gauthier
1Clinics of Pediatrics, Centre Hospitalier de Bicetre, Le Kremlin Bicetre, France.
Insights
Pediatric common bile duct (CBD) lithiasis in infants was successfully treated using radiological procedures, avoiding surgery in most cases. This minimally invasive approach resolved CBD stones with no recurrence observed during long-term follow-up.
Area of Science:
- Pediatric Gastroenterology
- Interventional Radiology
- Hepatobiliary Surgery
Background:
- Common bile duct (CBD) lithiasis is rare in infants.
- Infantile CBD stones can cause significant morbidity.
- Diagnosis and management in this age group present unique challenges.
Purpose of the Study:
- To report on the successful radiological management of CBD lithiasis in infants.
- To evaluate the efficacy and safety of minimally invasive techniques for stone removal.
- To assess long-term outcomes and recurrence rates.
Main Methods:
- Retrospective analysis of 10 infants (20 days to 11 months) with CBD lithiasis.
- Diagnostic imaging included ultrasound (US) and percutaneous transhepatic cholangiography (PTC).
- Interventional radiological procedures involved stone extraction via catheter or duodenal flushing, with temporary external drainage.
Main Results:
- US revealed bile duct (BD) dilatation in 9/10 infants, GB sludge in 5/10, and CBD sludge in 2/10.
- Histological findings confirmed cholangitis in 4/10 infants.
- Radiological procedures successfully removed CBD stones in all cases; 3 infants had subsequent surgery with no residual stones found.
Conclusions:
- Minimally invasive radiological procedures are effective for treating CBD lithiasis in infants.
- This approach avoids the need for surgery in the majority of cases.
- Long-term follow-up (10 months to 7 years) showed no recurrence, indicating durable treatment success.
Abstract:
The authors report a series of 10 infants aged from 20 days to 11 months, presenting with CBD lithiasis, explored and cured by radiological procedure. US showed BD dilatation in 9 cases, sludge in the GB in 5 and in the CBD in 2. Histological findings of cholangitis were present in 4 infants. PTC was performed by GB puncture in 6 and BD puncture in 4. There was evidence of a filling defect in CBD but no anatomical anomaly. Blackish concretions were removed through a side-holes catheter or pushed in the duodenum by washing with saline. An external drainage was left a few days to allow control cholangiogram. Three infants underwent subsequent surgery but no residual lithiasis was found. No recurrence has occurred with a follow-up ranging from 10 months to 7 years. Mechanisms of this entity are discussed.