Clinical Review and Case Report of Ceftriaxone-associated Gallbladder Pseudolithiasis in Adult

Abstract

Although ceftriaxone can be used safely in most instances, it can sometimes induce biliary sludge or stone formation. Most of the patients remain asymptomatic and children are more susceptible to develop this condition, but adults can be affected as well. Because sludge or stones disappear after discontinuing ceftriaxone, this condition is referred to as ceftriaxone-associated pseudolithiasis. A 54-year-old woman was admitted to a local clinic for management of ileus. During admission, she had received ceftriaxone and metronidazole, and had been on nil per os for the past 6 days. She was then referred to our hospital for cholecystectomy due to persistent right upper quadrant pain. Although imaging studies showed gallbladder sludge, pseudolithiasis was suspected because of ceftriaxone administration history and prolonged fasting. After careful watch-and-wait, the condition resolved spontaneously after ceftriaxone discontinuation. Our clear understanding on ceftriaxone-associated gallbladder pseudolithiasis allowed us to avoid an unnecessary cholecystectomy. Herein, we report the case of a 54-year-old woman with ceftriaxone-associated gallbladder pseudolithiasis that was successfully managed by ceftriaxone discontinuation alone.

Effect of ceftriaxone on intestinal transit time

“…7,8 Many studies have shown that ceftriaxone reduces bile flow and causes sludge and pseudolithiasis in the bile. [15][16][17][18] Gallstone and idiopathic constipation comorbidity have been detected. It was thought that these patients had hypomobility in the gallbladder and this might be due to the slowdown in all gastrointestinal tract movements.…”

“…Many studies have shown that ceftriaxone reduces bile flow and causes sludge and pseudolithiasis in the bile 15–18 . Gallstone and idiopathic constipation comorbidity have been detected.…”

Ceftriaxone-Induced Acute Pancreatitis in Patient with Liver Abscess

“…12 Notably, four cases of ceftriaxone-induced gallbladder pseudolithiasis have been reported in Korea, however no case of ceftriaxone-associated pancreatitis has been reported. [13][14][15] Of note, our patient received a large dosage of ceftriaxone over several weeks, which increased his risk of ceftriaxone-…”

Cholecystectomy during ceftriaxone therapy. A translational study with a new rabbit model

“…In the 1980s, Schaad et al 5 reviewed the ultrasound examinations of children under treatment with ceftriaxone and described the morphological similarity between hyperechogenic biliary precipitates and gallstones which supposedly would disappear in all patients after discontinuing treatment. Since then, several cases of pseudolithiasis have been reported [5][6][7] . This evidence has been mentioned in the drug's informational leaflet available to the consumer, also reporting improvement with no major risks upon the suspension of ceftriaxone use.…”