Sludge ball, pseudolithiasis, cholelithiasis and choledocholithiasis from intrauterine life to 2 years: a 13-year follow-up.
OBJECTIVE
Evaluation and follow-up of infants with cholelithiasis and pseudolithiasis in a pediatric ward.


METHODS
Prospective study from April 1990 to October 2003 identified hospitalized infants younger than 2 years with ultrasonographic findings of cholelithiasis, choledocholithiasis or pseudolithiasis. Associated abnormalities or contributory factors were recorded and patients were followed for from 6 months to 13 years (mean, 4 years).


RESULTS
Thirty-four patients were diagnosed between the age of 3 weeks and 24 months. Thirteen (38%) had been treated with third-generation cephalosporins. Other associated factors were dehydration in 10 (29%), urinary tract infection in two (6%) and one each for cholestatic liver disease, total parenteral nutrition, immunoglobulin A deficiency and prematurity. Six infants (17%) had no known risk factor. Six additional patients were diagnosed by antenatal ultrasound.


CONCLUSIONS
Cholelithiasis in infants hospitalized for a variety of common pediatric conditions is not rare. Dehydration and treatment with third-generation cephalosporins are important associated factors. The classic risk factors of hemolysis and previous gastrointestinal surgery, were not found in our group. The overall prognosis was good. Pseudolithiasis disappeared in all infants. Of the 21 infants with cholelithiasis, only two developed cholecystitis. In nine infants, spontaneous resolution occurred. In the absence of other clinical or imaging evidence of biliary tract disease, conservative management is advised.
Klar
Aharon
A
Department of Pediatrics, Hadassah University Hospital, Jerusalem, Israel. aklar@inter.net.il
Branski
David
D
Akerman
Yaacov
Y
Nadjari
Michael
M
Berkun
Yaacov
Y
Moise
Jonathan
J
Shazberg
Gila
G
Revel-Vilk
Shoshana
S
Israeli
Talia
T
Katz
Gabriel
G
Levy
Arie
A
Ami
Anat Ben
AB
Hurvitz
Haggit
H
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use*; D042883:Choledocholithiasis / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology*; D002769:Cholelithiasis / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology*; D003681:Dehydration / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D014463:Ultrasonography; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000209:etiology
D000900:Anti-Bacterial Agents; D002511:Cephalosporins