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Endoscopic sphincterotomy and laparoscopic cholecystectomy in an infant with cholecysto-choledocholithiasis
Y Sanada1, M Yamaguchi, M Chiba
1Department of Surgery, Showa University, Fujigaoka Hospital, Yokohama, Japan.
Insights
This study reports the first successful use of endoscopic sphincterotomy (EST) and laparoscopic cholecystectomy (LC) in an infant for bile duct stones. The combined procedure effectively treated choledocholithiasis and cholecystolithiasis without complications.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Biliary Tract Diseases
Background:
- Laparoscopic cholecystectomy (LC) and endoscopic sphincterotomy (EST) are standard treatments for gallstones in adults.
- Their application in infants for cholecysto-choledocholithiasis remains undocumented.
Observation:
- An 8-month-old infant presented with acute cholecystitis and obstructive jaundice due to bile duct stones.
- Initial antibiotic therapy resolved the acute symptoms and hepatic impairment.
- Endoscopic retrograde cholangiopancreatography (ERCP) confirmed gallstones in the common bile duct and gallbladder.
Findings:
- Endoscopic sphincterotomy (EST) successfully extracted a common bile duct stone using a basket catheter.
- Laparoscopic cholecystectomy (LC) was subsequently performed.
- The infant experienced no complications during a 6-month follow-up period.
Implications:
- This case demonstrates the feasibility and safety of combined EST and LC in infants for treating complex biliary stone disease.
- It expands the therapeutic options for pediatric patients with choledocholithiasis and cholecystolithiasis.
- Further research may explore the long-term outcomes and broader applicability of these minimally invasive techniques in neonates and infants.
Abstract:
Laparoscopic cholecystectomy (LC) and endoscopic sphincterotomy (EST) are widely accepted procedures for cholecysto-choledocholithiasis in adults. However, their use in infants has not been reported. An 8-month-old girl presented with high fever and obstructive jaundice. Ultrasound scan showed acute cholecystitis with stones in the bile duct. After 2-week-long antibiotic therapy the acute cholecystitis and hepatic impairment resolved. An endoscopic retrograde cholangiopancreatography (ERCP) confirmed choledocholithiasis and cholecystolithiasis. Risk factors for the development of biliary calculi were not detected. One month after the restoration of her liver function, she underwent EST using a side-viewing endoscope with a small sphincterotome. A common bile duct stone was extracted using a basket catheter. LC was then carried out. The time interval between the EST and LC was 34 days. No complications have been noted for 6 months.