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Laparoscopic Common Bile Duct Exploration for Choledocholithiasis-Induced Cholangitis in a 2-Month-Old Infant: A Case
Hajime Asai1, Takahisa Tainaka1, Chiyoe Shirota1
1Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Insights
A 2-month-old infant with biliary atresia underwent successful staged treatment. Percutaneous transhepatic gallbladder drainage followed by laparoscopic surgery resolved jaundice and liver issues, offering a minimally invasive option for infants.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neonatology
Background:
- Biliary obstruction in neonates presents significant management challenges.
- Infants with complex congenital heart defects have limited treatment options.
- Early diagnosis and intervention are crucial for outcomes in neonatal cholestasis.
Abstract:
A 2-month-old, 2.9-kg infant, who had previously undergone neonatal surgery for coarctation of the aorta and ventricular septal defect, developed acholic stools and jaundice on day of life (DOL) 55. Fasting and ursodeoxycholic acid therapy were initiated, but on DOL 61, she became febrile with elevated inflammatory markers and cholestatic enzymes. Ultrasound and computed tomography (CT) imaging showed marked dilatation of the gallbladder and common bile duct, with sludge/stones present. Given the severe cholangitis and poor cardiopulmonary reserve, urgent percutaneous transhepatic gallbladder drainage (PTGBD) was performed, resulting in rapid clinical stabilization. Tube cholangiography later confirmed a persistent distal stone and ongoing cholestasis. After recovery, a laparoscopic cholecystectomy with common bile duct exploration and saline irrigation was performed on DOL 81 to achieve complete stone clearance. The postoperative course was uncomplicated, with resolution of jaundice and normalization of liver function tests. In very small infants, endoscopic retrograde cholangiopancreatography (ERCP) may not be feasible; therefore, staged PTGBD followed by laparoscopic exploration offers a definitive, minimally invasive alternative approach.
