title: Common bile duct stones in infancy: a medical approach.
abstract: Symptomatic choledocholithiasis in infancy is not common. It usually presents with jaundice and acholic stools and is diagnosed on abdominal ultrasonography. Favourable outcome of conservative management has been reported, but specific management guidelines are not well defined in the literature. We describe three cases using a combination of ursodeoxycholic acid and antibiotics as a treatment paradigm, which could potentially negate more invasive treatment. All three patients had ultrasonography proven choledocholithiasis with concomitant obstructive liver function test. They were treated with a combination of ursodeoxycolic acid and antibiotics. Patient 1 had an Escherichia coli urinary tract infection and was treated with oral bactrim. Intravenous amoxicillin, gentamicin and metronidazole were used for the other two patients. All three patients responded with a return to normal-coloured stools within 48 h of combination treatment. Repeat ultrasonography done within 11 days after the first study for all three patients confirmed complete resolution of choledocholithiasis. It is postulated that this improvement is as a result of a reduction in inflammation and oedema, associated with a low-grade cholangitis, following antibiotic treatment. This is coupled with improved bile flow with ursodeoxycholic acid therapy. The findings suggest the potential application of this safe, non-invasive therapeutic strategy as initial management in infants with this condition. A follow-up prospective randomised controlled trial may be an answer to prove the validity of this observation but due to the rarity of this problem, it would be a challenge to recruit sufficient number of patients.
authors.affiliation: Departments of Gastroenterology and Clinical Nutrition General Surgery Medical Imaging, Royal Children's Hospital, Flemington Road, Melbourne, VIC 3052, Australia. naznee@hotmail.com
authors.forename: Nazrul
authors.initials: N
authors.lastname: Nordin
authors.forename: George
authors.initials: G
authors.lastname: Alex
authors.forename: Tom
authors.initials: T
authors.lastname: Clarnette
authors.forename: Nicola
authors.initials: N
authors.lastname: Stephens
authors.forename: Mark
authors.initials: M
authors.lastname: Oliver
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002756:Cholagogues and Choleretics / Q000627:therapeutic use*; D003135:Common Bile Duct / Q000000981:diagnostic imaging / Q000473:pathology; D004359:Drug Therapy, Combination; D005260:Female; D042882:Gallstones / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D008297:Male; D016896:Treatment Outcome; D014463:Ultrasonography; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D002756:Cholagogues and Choleretics; D014580:Ursodeoxycholic Acid