Choledocholithiasis in an infant of extremely low birthweight

Maruyama, Kei; Koizumi, Toru

doi:10.1046/j.1440-1754.2002.00785.x

Cited by 9 publications

(4 citation statements)

References 14 publications

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“…reported resolution of choledocholithiasis in three infants within 10–17 days following treatment with oral phenobarbitone, 7 and Maruyama and Koizumi have previously published a case report on the success of antibiotics, dehydrocholic acid and ursodeoxycholic acid combination in managing choledocholithiasis in a premature infant. However, it took 32 days for the stone to disappear, and the patient described in the case report did not have evidence of total obstruction at the time of diagnosis 8 …”

Section: Discussionmentioning

confidence: 92%

“…However, it took 32 days for the stone to disappear, and the patient described in the case report did not have evidence of total obstruction at the time of diagnosis. 8 Ursodeoxycholic acid has been shown to effectively dissolve cholesterol stones in appropriately selected patients. 9 The desired choleresis effect is probably achieved by increasing the capacity of bile duct cells to secrete bile acids as observed in patients with primary sclerosing cholangitis.…”

Section: Discussionmentioning

confidence: 99%

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Common bile duct stones in infancy: A medical approach

Nordin¹,

Alex²,

Clarnette³

et al. 2012

J Paediatrics Child Health

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Symptomatic choledocholithiasis in infancy is not common. It usually presents with jaundice and acholic stools and is diagnosed on abdominal ultrasonography. Favourable outcome of conservative management has been reported, but specific management guidelines are not well defined in the literature. We describe three cases using a combination of ursodeoxycholic acid and antibiotics as a treatment paradigm, which could potentially negate more invasive treatment. All three patients had ultrasonography proven choledocholithiasis with concomitant obstructive liver function test. They were treated with a combination of ursodeoxycolic acid and antibiotics. Patient 1 had an Escherichia coli urinary tract infection and was treated with oral bactrim. Intravenous amoxicillin, gentamicin and metronidazole were used for the other two patients. All three patients responded with a return to normal-coloured stools within 48 h of combination treatment. Repeat ultrasonography done within 11 days after the first study for all three patients confirmed complete resolution of choledocholithiasis. It is postulated that this improvement is as a result of a reduction in inflammation and oedema, associated with a low-grade cholangitis, following antibiotic treatment. This is coupled with improved bile flow with ursodeoxycholic acid therapy. The findings suggest the potential application of this safe, non-invasive therapeutic strategy as initial management in infants with this condition. A follow-up prospective randomised controlled trial may be an answer to prove the validity of this observation but due to the rarity of this problem, it would be a challenge to recruit sufficient number of patients.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Common bile duct stones in infancy: A medical approach

Nordin¹,

Alex²,

Clarnette³

et al. 2012

J Paediatrics Child Health

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“…Medical management with ursodeoxycholic acid is recommended in neonates with choledocholithiasis if they are asymptomatic or with mild symptoms. Antibiotics can aid in the resolution of stones in neonates who have signs of infection [ 5 , 11 , 12 ]. In a study of 13 infants with gallstones, 10 remained asymptomatic without surgical management, and stones resolved on their own in 5 of them, with the other 5 either lost to follow-up or with persistent calcified gallstones [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Rolling stones: an instructive case of neonatal cholestasis

et al. 2022

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Background Jaundice within the first 1–2 weeks of a neonate’s life will generally self-resolve; however, if it lasts longer than this time frame it warrants further work up. Direct or conjugated hyperbilirubinemia can suggest neonatal cholestasis, which in turn reflects marked reduction in bile secretion and flow. The differential diagnosis for neonatal cholestasis is broad. Neonatal choledocholithiasis is a rare cause of neonatal cholestasis, but should be considered on the differential diagnosis for patients presenting with elevated conjugated bilirubin. Case presentation We describe an infant who presented with neonatal cholestasis. He subsequently underwent work up for biliary atresia, as this is one of the more time-sensitive diagnoses that must be made in neonates with conjugated hyperbilirubinemia. He was ultimately found to have choledocholithiasis on magnetic resonance cholangiopancreatography. He was managed conservatively with optimizing nutrition and ursodeoxycholic acid therapy. Conclusions We found that conservative management, specifically optimizing nutrition and treating with ursodeoxycholic acid, can be a sufficient approach to facilitating resolution of the choledocholithiasis and conjugated hyperbilirubinemia.

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“…Cases of infant cholelithiasis are often associated with hemolytic disorders, congenital abnormalities of the biliary tree or total parenteral nutrition, and are primarily asymptomatic (1). Choledocholithiasis, which is often symptomatic, is rarely encountered in infants and is documented in only a limited number of published reports (2,3). Endoscopic retrograde cholangiopancreatography (ERCP) is the standard management technique of choledocholithiasis in adults (4).…”

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confidence: 99%