Clinical management of infantile cholelithiasis

Cerine Jeanty, S. Christopher Derderian, Jesse Courtier, Shinjiro Hirose

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Purpose Infantile cholelithiasis is a rare disease process, and management strategies are poorly defined. We therefore examined the risk factors, complications, and management of this disease at our institution. Methods We retrospectively reviewed infants with cholelithiasis diagnosed on ultrasound between 1997 and 2013. Details of the patient's medical history, presentation, imaging findings, laboratory values, and treatment were reviewed and analyzed. Results Over the 16-year period, 50 infants were evaluated for cholelithiasis. Thirty-seven (74%) had at least one risk factor for gallstone development which included total parenteral nutrition, diuretic therapy, cephalosporin antibiotic treatment, sepsis, congenital heart disease (CHD), prematurity, or a malabsorptive gastrointestinal condition. Thirteen (26%) infants were symptomatic, most commonly presenting with emesis and jaundice. Complications from gallstones included choledocholithiasis (9), cholecystitis (3), and pancreatitis (1). Nearly half (6/13) of patients with complicated cholelithiasis had CHD. Of infants presenting with complications, 9 had a cholecystectomy, most commonly via a laparoscopic approach, 2 had an ERCP for choledocholithiasis, and 2 were medically managed. In patients managed conservatively, resolution of gallstones occurred in 25%. Conclusions Infantile cholelithiasis has variable outcomes ranging from spontaneous resolution to choledocholithiasis or cholecystitis. While patients with complicated cholelithiasis often undergo an operation, infants < 1 year of age have higher anesthetic and surgical risks. Conservative management with ERCP or medical treatment can also be successful, which offers an alternative to operative intervention in properly selected patients.

Original languageEnglish (US)
Pages (from-to)1289-1292
Number of pages4
JournalJournal of Pediatric Surgery
Volume50
Issue number8
DOIs
StatePublished - Aug 1 2015
Externally publishedYes

Fingerprint

Cholelithiasis
Choledocholithiasis
Gallstones
Cholecystitis
Endoscopic Retrograde Cholangiopancreatography
Heart Diseases
Nutrition Therapy
Total Parenteral Nutrition
Risk Management
Cholecystectomy
Cephalosporins
Disease Management
Rare Diseases
Jaundice
Diuretics
Pancreatitis
Vomiting
Anesthetics
Sepsis
Therapeutics

Keywords

  • Cholecystectomy
  • Gallstones
  • Key words Infant cholelithiasis

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Clinical management of infantile cholelithiasis. / Jeanty, Cerine; Derderian, S. Christopher; Courtier, Jesse; Hirose, Shinjiro.

In: Journal of Pediatric Surgery, Vol. 50, No. 8, 01.08.2015, p. 1289-1292.

Research output: Contribution to journalArticle

Jeanty, Cerine ; Derderian, S. Christopher ; Courtier, Jesse ; Hirose, Shinjiro. / Clinical management of infantile cholelithiasis. In: Journal of Pediatric Surgery. 2015 ; Vol. 50, No. 8. pp. 1289-1292.
@article{c1b6d91e00644eae96dc60dff2356dec,
title = "Clinical management of infantile cholelithiasis",
abstract = "Purpose Infantile cholelithiasis is a rare disease process, and management strategies are poorly defined. We therefore examined the risk factors, complications, and management of this disease at our institution. Methods We retrospectively reviewed infants with cholelithiasis diagnosed on ultrasound between 1997 and 2013. Details of the patient's medical history, presentation, imaging findings, laboratory values, and treatment were reviewed and analyzed. Results Over the 16-year period, 50 infants were evaluated for cholelithiasis. Thirty-seven (74{\%}) had at least one risk factor for gallstone development which included total parenteral nutrition, diuretic therapy, cephalosporin antibiotic treatment, sepsis, congenital heart disease (CHD), prematurity, or a malabsorptive gastrointestinal condition. Thirteen (26{\%}) infants were symptomatic, most commonly presenting with emesis and jaundice. Complications from gallstones included choledocholithiasis (9), cholecystitis (3), and pancreatitis (1). Nearly half (6/13) of patients with complicated cholelithiasis had CHD. Of infants presenting with complications, 9 had a cholecystectomy, most commonly via a laparoscopic approach, 2 had an ERCP for choledocholithiasis, and 2 were medically managed. In patients managed conservatively, resolution of gallstones occurred in 25{\%}. Conclusions Infantile cholelithiasis has variable outcomes ranging from spontaneous resolution to choledocholithiasis or cholecystitis. While patients with complicated cholelithiasis often undergo an operation, infants < 1 year of age have higher anesthetic and surgical risks. Conservative management with ERCP or medical treatment can also be successful, which offers an alternative to operative intervention in properly selected patients.",
keywords = "Cholecystectomy, Gallstones, Key words Infant cholelithiasis",
author = "Cerine Jeanty and Derderian, {S. Christopher} and Jesse Courtier and Shinjiro Hirose",
year = "2015",
month = "8",
day = "1",
doi = "10.1016/j.jpedsurg.2014.10.051",
language = "English (US)",
volume = "50",
pages = "1289--1292",
journal = "Journal of Pediatric Surgery",
issn = "0022-3468",
publisher = "W.B. Saunders Ltd",
number = "8",

}

TY - JOUR

T1 - Clinical management of infantile cholelithiasis

AU - Jeanty, Cerine

AU - Derderian, S. Christopher

AU - Courtier, Jesse

AU - Hirose, Shinjiro

PY - 2015/8/1

Y1 - 2015/8/1

N2 - Purpose Infantile cholelithiasis is a rare disease process, and management strategies are poorly defined. We therefore examined the risk factors, complications, and management of this disease at our institution. Methods We retrospectively reviewed infants with cholelithiasis diagnosed on ultrasound between 1997 and 2013. Details of the patient's medical history, presentation, imaging findings, laboratory values, and treatment were reviewed and analyzed. Results Over the 16-year period, 50 infants were evaluated for cholelithiasis. Thirty-seven (74%) had at least one risk factor for gallstone development which included total parenteral nutrition, diuretic therapy, cephalosporin antibiotic treatment, sepsis, congenital heart disease (CHD), prematurity, or a malabsorptive gastrointestinal condition. Thirteen (26%) infants were symptomatic, most commonly presenting with emesis and jaundice. Complications from gallstones included choledocholithiasis (9), cholecystitis (3), and pancreatitis (1). Nearly half (6/13) of patients with complicated cholelithiasis had CHD. Of infants presenting with complications, 9 had a cholecystectomy, most commonly via a laparoscopic approach, 2 had an ERCP for choledocholithiasis, and 2 were medically managed. In patients managed conservatively, resolution of gallstones occurred in 25%. Conclusions Infantile cholelithiasis has variable outcomes ranging from spontaneous resolution to choledocholithiasis or cholecystitis. While patients with complicated cholelithiasis often undergo an operation, infants < 1 year of age have higher anesthetic and surgical risks. Conservative management with ERCP or medical treatment can also be successful, which offers an alternative to operative intervention in properly selected patients.

AB - Purpose Infantile cholelithiasis is a rare disease process, and management strategies are poorly defined. We therefore examined the risk factors, complications, and management of this disease at our institution. Methods We retrospectively reviewed infants with cholelithiasis diagnosed on ultrasound between 1997 and 2013. Details of the patient's medical history, presentation, imaging findings, laboratory values, and treatment were reviewed and analyzed. Results Over the 16-year period, 50 infants were evaluated for cholelithiasis. Thirty-seven (74%) had at least one risk factor for gallstone development which included total parenteral nutrition, diuretic therapy, cephalosporin antibiotic treatment, sepsis, congenital heart disease (CHD), prematurity, or a malabsorptive gastrointestinal condition. Thirteen (26%) infants were symptomatic, most commonly presenting with emesis and jaundice. Complications from gallstones included choledocholithiasis (9), cholecystitis (3), and pancreatitis (1). Nearly half (6/13) of patients with complicated cholelithiasis had CHD. Of infants presenting with complications, 9 had a cholecystectomy, most commonly via a laparoscopic approach, 2 had an ERCP for choledocholithiasis, and 2 were medically managed. In patients managed conservatively, resolution of gallstones occurred in 25%. Conclusions Infantile cholelithiasis has variable outcomes ranging from spontaneous resolution to choledocholithiasis or cholecystitis. While patients with complicated cholelithiasis often undergo an operation, infants < 1 year of age have higher anesthetic and surgical risks. Conservative management with ERCP or medical treatment can also be successful, which offers an alternative to operative intervention in properly selected patients.

KW - Cholecystectomy

KW - Gallstones

KW - Key words Infant cholelithiasis

UR - http://www.scopus.com/inward/record.url?scp=84954544133&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84954544133&partnerID=8YFLogxK

U2 - 10.1016/j.jpedsurg.2014.10.051

DO - 10.1016/j.jpedsurg.2014.10.051

M3 - Article

C2 - 25783306

AN - SCOPUS:84954544133

VL - 50

SP - 1289

EP - 1292

JO - Journal of Pediatric Surgery

JF - Journal of Pediatric Surgery

SN - 0022-3468

IS - 8

ER -