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Cholelithiasis in infancy: resolution of gallstones in three of four infants
Insights
Infantile cholelithiasis, or gallstones in infants, may resolve spontaneously. This study suggests a conservative approach may be suitable for asymptomatic cases, challenging previous beliefs about severity.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Medical Imaging
Background:
- Infantile cholelithiasis is considered rare and often associated with severe morbidity and mortality.
- Predisposing factors include hemolysis, prolonged fasting, biliary abnormalities, and total parenteral nutrition (TPN).
Observation:
- Four infants aged 3 weeks to 6 months were diagnosed with gallstones via ultrasonography.
- One infant had hemolytic disease; the other three had incidental findings.
- A repeat sonogram revealed spontaneous resolution in the infant with hemolysis.
Findings:
- Two additional infants experienced spontaneous resolution of gallstones.
- One child maintained an asymptomatic gallstone at 16 months of age.
- These findings challenge the assumption of inevitable severe outcomes.
Implications:
- A conservative, watchful approach may be appropriate for asymptomatic infantile cholelithiasis.
- Further research is needed to understand the natural history and optimal management of pediatric gallstones.
- Ultrasonography plays a key role in diagnosing and monitoring gallstone resolution in infants.
Abstract:
Cholelithiasis in infancy is believed to be a rare finding. It is also held that all cholelithiasis in infancy has a predisposing factor such as hemolysis, prolonged fasting, congenital abnormality of the biliary tree, or the administration of TPN and is associated with severe morbidity and mortality. In the last three years, four infants at our hospital have been found on real-time ultrasonography to have gallstones. Their ages ranged from 3 weeks to 6 months. One patient had a hemolytic disease but the finding of cholelithiasis in the other three patients was incidental. A repeat sonogram in the infant with hemolysis three months after initial recognition and one day before scheduled cholecystectomy revealed spontaneous resolution of the gallstones. This led us to a conservative approach in the other three patients. Two more infants had spontaneous resolution of their gallstones and one child, now aged 16 months, is thriving with a persistent asymptomatic gallstone visible on sonogram.