Infant cholelithiasis: Report of a case

Abstract

Cholelithiasis is an extremely unusual finding in infancy. The following article describes the case of a 2-month-old male with a VACTER association who presented with persistent and progressive obstructive jaundice and acholic stool due to cholelithiasis. Thirty cases under the age of 1, including our case, have previously been reported in the Japanese literature. Twenty-eight cases had predisposing factors. The calculi were present only in the gallbladder in 18 cases, in the common bile duct or cystic duct or both in 7 cases, and in the gallbladder and common bile duct in 3 cases. Ten cases of stones were radiopaque, which thus made the plain abdominal roentgenogram findings very valuable. Nine cases underwent operation including cholecystectomy in 3 cases, choledocholithotomy in 3 cases, and cholecystolithotomy in 1 case, while the procedure was unknown in 2 cases. Recently, the number of reported cases of cholelithiasis in infants has gradually increased and today these cases are most often diagnosed by ultrasonography, because the examination is easy to perform and not invasive.

Extrahepatic portal vein thrombosis is associated with an increased incidence of cholelithiasis

“…[4][5][6][7] Possible etiologies for gallstone formation include total parenteral nutrition (TPN) administration, 8 extensive small bowel resection, 9 and conditions associated with a hemolytic process such as sickle cell disease, 10 hereditary spherocytosis, thalassemia major, or autoimmune hemolytic anemia. 11 Any disturbance to the normal concentration ratio between bile salt, cholesterol, and lecithin predisposes to gallstone formation.…”

Choledocholithiasis in an infant of extremely low birthweight

“…Premature birth is one of the factors predisposing to cholelithiasis in infancy, 1 but choledocholithiasis in infants with birth weights of less than 1000 g has been rarely reported, and management is uncertain 2,3 . We describe a 5‐month‐old female infant of extremely low birthweight in whom choledocholithiasis developed.…”

Gallstones in an infant with pyloric stenosis

“…The incidence of gallstones in children is 0.13–2.2%, 2,3 much less than that in adults. Gallstones are usually reported among older children with hemolytic disorders.…”

“…Gallstone disease is rare in infancy 1–5 . Usually, some underlying aetiology is identifiable when gallstones are diagnosed in younger children, for example, total parenteral nutrition, ileal resection, sepsis, dehydration etc 2,5,6 . However, only one case of gallstones with pyloric stenosis (PS) has been reported so far in the English literature 7 .…”

“…Other workers have also noted that most gallstones detected in infants resolve over time once the underlying pathology is dealt with. Gall bladder surgery is recommended only if there is a ductal pathology or the patient is symptomatic 2,3,6 …”