#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Cholelithiasis in Neonates – a Common Phenomenon


Authors: R. Vaňatka
Authors‘ workplace: I. rádiologická klinika LFUK a FNsP, Bratislava prednosta prof. MUDr. J. Bilický, CSc.
Published in: Čes-slov Pediat 2008; 63 (5): 248-255.
Category: Original Papers

Overview

Background:
Cholelithiasis in neonates and infants has been rarely reported, but with the current widespread use of diagnostic abdominal ultrasonography more neonates may be found with gallstones. The clinical situations include symptomless cases with spontaneous resolution and relatively rare cases with serious complications due to choledocholithiasis.

Aim:
To determine the incidence, spontaneous course and the complications of cholelithiasis in neonates. A review on the various forms of cholelithiasis in neonatal age has been also carried out.

Patients and methods:
Three hundred and thirty nine neonates were screened during 4 months (March – June 2005) by abdominal ultrasound (Aloka SSD-1400, probe 7.5 MHz). There were 273 physiologic newborns (otherwise healthy newborns with no medical history of factors potentially predisposing to stones) and 66 pathologic neonates (pathologic course of perinatal period). Abdominal ultrasonography was performed at the first 5 days of life (physiologic newborns) or as soon as possible (pathologic newborns). Neonates with the diagnosis of the echogenic material in the gallbladder were prospectively followed up in 1-month periods until this US finding was present.

Results:
The presence of the echogenic material in the gallbladder were diagnosed in five physiologic newborns (1.8%, 3 girls and 2 boys). True gallstones with acoustic shadow, sludge-balls and sludge were diagnosed in one, three and one of them, respectively. The presence of the echogenic material in the gallbladder were also found in four pathologic newborns (6.1%, 2 girls and 2 boys). True gallstones, sludge-balls and sludge were diagnosed in two, one and one of them, respectively. No significant sex predominancy was found (5 girls and 4 boys). At follow-up the biliary stones in all five physiologic infants had spontaneously completely resolved at the age of 1 month with no symptoms. In three of four pathologic newborns this findings has reminded in the third month of theirs life. All children were asymptomatic from the biliary system.

Conclusions:
The present study suggests that idiopathic neonatal cholelithiasis seems to be more common phenomenon than previously suspected – our research showed an incidence of 0.36% of true gallstones and 1.8% of the presence of echogenic material in the gallbladder in physiologic newborns. There could be the maternal and delivery predisposing factors that disappear after delivery and so the connatal gallstones often disappear spontaneously. The incidence of “pathologic” neonatal cholelithiasis related to the predisposing factors (prematurity, total parenteral nutrition, neonatal sepsis, dehydratation, furosemide therapy etc.) has been estimated also higher than expected – incidence of 3.0% of true gallstones and 6.1% of the presence of echogenic material in the gallbladder in the pathologic newborns group. Difference of incidence in physiologic vs. pathologic newborns confirm that predisposing factors plays an important role in the pathogenesis of neonatal cholelithiasis.

The most frequent evolution is spontaneous resolution of the biliary echogenic images in absence of clinical manifestations. The complications are rare.

Thus we conclude that the incidentally diagnosed neonatal cholelithiasis can be considered as a relatively common phenomenon, with good prognosis and rare complications. If it is asymptomatic, no treatment is needed except for abdominal sonography follow-up until this finding is present. In the symptomatic cases the therapy is to be chosen in each case in accordance with clinical features.

Key words:
cholelithiasis, neonate, ultrasonography


Sources

1. Agnifili A, Gola P, Marino M, Carducci G, Mancini E, et al. Biliary lithiasis in childhood. A spectrum of diseases with different clinical significance during fetal life, childhood and adolescence. Minerva Pediatr. 1998;50(4): 127–136.

2. Akkurt I, Kuhnle U, Ringenberg C. Pseudohypo-aldosteronism and cholelithiasis: coincidence or pathogenetic correlation? Eur. J. Pediatr. 1997;156(5): 363–366.

3. Al-Garni A, Leung AK, Kao CP. Cholelithiasis in an infant with Klinefelter’s syndrome. South Med. J. 2002;95(9): 1063–1064.

4. Almond PS, Adolph VR, Steiner R, Hill CB, Falterman KW, Arensman RM. Calculous disease of the biliary tract in infants after neonatal extracorporeal membrane oxygenation. J. Perinatol. 1992;12(1): 18–20.

5. Asabe K, Handa N. Infant cholelithiasis: report of a case. Surg. Today 1997;27(1): 71–75.

6. Aughton DJ, Gibson P, Cacciarelli A. Cholelithiasis in infants with Down syndrome. Three cases and literature review. Clin. Pediatr. (Phil.) 1992;31(11): 650–652.

7. Bonnet JP, Abid L, Dabhar A, Levy A, Soulier Y, Blangy S. Early biliary pseudolithiasis during ceftriaxone therapy for acute pyelonephritis in children: a prospective study in 34 children. Eur. J. Pediatr. Surg. 2000;10(6): 368–371.

8. Brown DL, Teele RL, Doubilet PM, DiSalvo DN, Benson CB, Van Alstyne GA. Echogenic material in the fetal gallbladder: sonographic and clinical observations. Radiology 1992;182(1): 73–76.

9. Debray D, Pariente D, Gauthier F, Myara A, Bernard O. Cholelithiasis in infancy: a study of 40 cases. J. Pediatr. 1993;122(3): 385–391.

10. Gertner M, Farmer DL. Laparoscopic cholecystecomy in a 16-day-old infant with chronic cholelithiasis. J. Pediatr. Surg. 2004;39(1): 17–19.

11. Hanaki K, Ohzeki T, Iitsuka T, Nagata I, Urashima H, et al. An infant with pseudohypoaldosteronism accompanied by cholelithiasis. Biol. Neonate 1994;65(2): 85–88.

12. Hertzberg BS, Kliewer MA. Fetal gallstones in a contracted gallbladder: potential to simulate hepatic or peritoneal calcification. J. Ultrasound Med. 1998;17(10): 667–670.

13. Jojart G. Congenital cholelithiasis. Orv. Hetil. 1995;136(2): 67–70.

14. Ljung R, Ivarsson S, Nilsson P, Solvig J, Wattsgard C, Borulf S. Cholelithiasis during the first year of life: case reports and literature review. Acta Paediatr. 1992;81(1): 69–72.

15. Morad Y, Ziv N, Merlob P. Incidental diagnosis of asymptomatic neonatal cholelithiasis: case report and literature review. J. Perinatol. 1995;15(4): 314–317.

16. Radetti G, Gentili L, Paganini C, Messner H. Cholelithiasis in a newborn following treatment with the somatostatin analogue octreotide. Eur. J. Pediatr. 2000;159(7): 550.

17. Randall LH, Shaddy RE, Sturtevant JE, Reid BS, Molteni RA. Cholelithiasis in infants receiving furosemide: a prospective study of the incidence and one-year follow-up. J. Perinatol. 1992;12(2): 107–111.

18. Rhoads K, Snyder J, Lee H. Cholelithiasis and perforated gallbladder in an infant. J. Pediatr. Surg. 2002;37(9): 1374–1375

19. Riccabona M, Kerbl R, Schwinger W, Spork D, Millner M, Grubbauer HM. Ceftriaxone-induced cholelithiasis – a harmless side-effect? Klin. Pädiatr. 1993;205(6): 421–423.

20. Stringer MD, Lim P, Cave M, Martinez D, Lilford RJ. Fetal gallstones. J. Pediatr. Surg. 1996;31(11): 1589–1591.

21. St-Vil D, Yazbeck S, Luks FI, Hancock BJ, Filiatrault D, Youssef S. Cholelithiasis in newborns and infants. J. Pediatr. Surg. 1992;27(10): 1305–1307.

22. Suma V, Marini A, Bucci N, Toffolutti T, Talenti E. Fetal gallstones: sonographic and clinical observations. Ultrasound Obstet. Gynecol. 1998;12(6): 439–441.

23. Volf V, Vondráková L, Votruba M, Zikmund J, Votava F. Cholelitiáza v dětském věku. Čes.-slov. Pediat. 2003;58(10): 637–641.

24. Wendtland-Born A, Wiewrodt B, Bender SW, Weitzel D. Prevalence of gallstones in the neonatal period. Ultraschall Med. 1997;18(2): 80–83.

25. Zeman L, Petrů O, Rygl M, Keil R, Pýcha K, Vyhnánek M, Hříbal Z, Šnajdauf J. Terapie komplikované cholelitiázy u dětí. Čes.-slov. Pediat. 2004;59(12): 624–628.

Labels
Neonatology Paediatrics General practitioner for children and adolescents
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#