Sludge Ball, Pseudolithiasis, Cholelithiasis and Choledocholithiasis from Intrauterine Life to 2 Years: A 13‐Year Follow‐Up

Abstract

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.

Inspissated Bile Syndrome in a Neonate Treated With Cefotaxime

“…7 Cefotaxime, a third-generation cephalosporin, was previously reported to be associated with pseudolithiasis in 2 of 34 infants (6%) who had cholelithisis. 1 This relationship was not found in 38 older children receiving cefotaxime for 4 to 7 days. 3 Therefore, this association may be unique in the neonatal population.…”

“…6 There are many predisposing factors to the development of inspissated bile, sludge, or cholelithiasis in neonates. [1][2][3] Ceftriaxone pseudolithiasis, composed of precipitated ceftriaxone, is reported to occur in 29.5% to 45.7% of children treated with ceftriaxone. 3 The pseudolithiasis occurs after 4 to 22 days (mean, 9 days) of ceftriaxone therapy and resolves after 2 to 63 days (mean, 15 days) from the end of treatment.…”

Choledocholithiasis in a 4-month-old infant

“…Dehydration and urinary tract infection have also been associated with gallstones in children [4]. In the study of Friesen and Roberts [3], the etiology of gallstones in infants between 0 and 6 months included idiopathic causes (36.4%), total parenteral nutrition (30%), abdominal surgery (30%), sepsis (15%), bronchopulmonary dysplasia (13%), hemolytic disease (5.5%), malabsorption (5.5%), necrotizing enterocolitis (5.5%), and hepatobiliary disease (3.6%).…”

Revival of Landing's Concept of Infantile Obstructive Cholangiopathy – A Plea to Hand Over the 2 Week Old Jaundiced Full Term Neonate to the Surgeon!

“…The diagnosis of sludge is almost always based on imaging. The pathogenesis of sludge is similar to that of gallstones, which are formed from precipitating sludge 30 . There are many predisposing factors to the development of inspissated bile, sludge, or cholelithiasis in neonates 31,32 Ceftriaxone pseudolithiasis, composed of precipitated ceftriaxone, is reported to occur in 29.5% to 45.7% of children treated with ceftriaxone 33 .…”