Non-congenital biliary disease in infants

Non-congenital biliary diseases in infants, such as inspissated bile syndrome, hemolysis-related cholelithiasis, and recurrent pyogenic cholangitis, can lead to significant morbidity due to biliary obstruction and hepatic dysfunction. Diagnosis typically involves clinical evaluation, liver function testing, and imaging, with ultrasound as the first-line modality. Management depends on the underlying etiology and severity, with many cases resolving through supportive care, removal of offending agents, and bile acid therapy. Surgical intervention is indicated for persistent or complicated cases. While endoscopic retrograde cholangiopancreatography (ERCP) is often limited in neonates due to technical constraints, laparoscopic common bile duct exploration (LCBDE) has emerged as a viable alternative, offering ductal clearance through transcystic or direct approaches. Techniques such as power flushing, balloon sphincteroplasty, and stone retrieval devices have shown success in pediatric populations. Long-term follow-up is essential to monitor for recurrence, particularly in patients with ongoing hemolytic disorders. Continued research and innovation are needed to optimize diagnostic and therapeutic strategies for these complex conditions in infants.