Hypothesis: Endoscopic retrograde cholangiopancreatography (ERCP) is frequently used preoperatively in adult patients with suspected choledocholithiasis. Cholelithiasis occurs much less often in children, and the indications for ERCP are not established. We hypothesized that the natural history of choledocholithiasis in children is spontaneous passage of stones through the papilla and that these children can be managed without routine preoperative ERCP.
Design: Retrospective analysis of patients treated over a 10-year period.
Setting: Tertiary care children's hospital.
Patients: All patients with cholecystectomy for biliary disease.
Interventions: Cholecystectomy; intraoperative cholangiography for suspected choledocholithiasis: hyperbilirubinemia, gallstone pancreatitis, and ultrasonographic evidence of common bile duct dilation or common bile duct stones; and postoperative ERCP for symptomatic choledocholithiasis: pain and jaundice.
Main Outcome Measures: Incidence and complications of choledocholithiasis and frequency of ERCP.
Results: One hundred patients (63 females) were studied. Indications included acute cholecystitis (10%), chronic cholecystitis (59%), gallstone pancreatitis (26%), and choledocholithiasis (5%). An intraoperative cholangiography was performed in 45 patients, and common bile duct stones were identified in 13. Expectant management of asymptomatic common bile duct stones was associated with sonographic resolution within 1 week. One patient with intraoperative cholangiography-proven choledocholithiasis required ERCP for symptoms 24 hours after operation. One additional patient, who did not undergo intraoperative cholangiography, developed symptomatic choledocholithiasis and required ERCP. There were no choledocholithiasis- or ERCP-related complications.
Conclusions: This study suggests that choledocholithiasis occurs frequently in children and that spontaneous passage of common bile duct stones is common. This could explain the relatively high incidence of gallstone pancreatitis. Conservative management of choledocholithiasis is successful in the majority of patients. Routine preoperative or postoperative ERCP is usually not indicated.
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http://dx.doi.org/10.1001/archsurg.140.4.359 | DOI Listing |
BMC Infect Dis
January 2025
Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan.
Background: Mycobacterium avium complex (MAC) is a common pathogen causing non-tuberculous mycobacterial infections, primarily affecting the lungs. Disseminated MAC disease occurs mainly in immunocompromised individuals, such as those with acquired immunodeficiency syndrome, hematological malignancies, or those positive for anti-interferon-γ antibodies. However, its occurrence in solid organ transplant recipients is uncommon.
View Article and Find Full Text PDFUpdates Surg
January 2025
Department of Hepatic-Biliary-Pancreatic Surgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui, China.
This study aims to compare the efficacy of laparoscopic cholecystectomy combined with laparoscopic transcystic common bile duct exploration (LTCBDE), laparoscopic common bile duct exploration (LCBDE), and endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of gallbladder stones with common bile duct stones. We conducted a retrospective comparative analysis based on surgical time, intraoperative blood loss, postoperative recovery metrics, total hospitalization costs, gastrointestinal quality of life index (GIQLI) before and after surgery, and the incidence of postoperative complications. No significant differences were found among the three groups in terms of the surgical success rate, first stone clearance rate, intraoperative blood loss, incidence of postoperative complications, and stone recurrence rate (p > 0.
View Article and Find Full Text PDFMetabolomics
January 2025
Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Introduction: Preeclampsia (PE) is a common vascular pregnancy disorder affecting maternal and fetal metabolism with severe immediate and long-term consequences in mothers and infants. During pregnancy, metabolites in the maternal circulation pass through the placenta to the fetus. Meconium, a first stool of the neonate, offers a view to maternal and fetoplacental unit metabolism and could add to knowledge on the effects of PE on the fetus and newborn.
View Article and Find Full Text PDFSemin Pediatr Surg
January 2025
Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; Dr Li Dak-Sum Research Centre, The University of Hong Kong - Karolinska Institutet Collaboration in Regenerative Medicine, Hong Kong, China. Electronic address:
Biliary atresia (BA) is a severe neonatal cholestatic disorder marked by fibro-obliteration of the extrahepatic and intrahepatic bile ducts. It is the most common cause of pediatric end-stage liver disease and the leading indication for liver transplantation in children. There is significant heterogeneity in the etiology, involving various genetic and environmental factors such as viral infection, immune dysregulation and genetic predisposition to defective hepatobiliary development.
View Article and Find Full Text PDFFood Chem
January 2025
State Key Laboratory for Managing Biotic and Chemical Threats to the Quality and Safety of Agro-products, Key Laboratory of Animal Protein Deep Processing Technology of Zhejiang, Zhejiang-Malaysia Joint Research Laboratory for Agricultural Product Processing and Nutrition, College of Food Science and Engineering, Ningbo University, Ningbo, Zhejiang, China. Electronic address:
Dietary polyphenols represent a diverse group of plant-derived compounds known for their extensive biological activities, offering significant promise in the prevention and treatment of various chronic illnesses. Despite their potential, advancements in their research have been curtailed by challenges in structural analysis and limitations in existing research models. This review marks a pioneering exploration into how bile acids, gut microbiota, and the gut-brain axis serve as conduits through which dietary polyphenols can exert therapeutic effects on Inflammatory Bowel Disease (IBD).
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