Sphincterotomy for jaundice in a neonate

Endoscopic sphincterotomy is a useful preoperative management for refractory pancreatitis associated with pancreaticobiliary maljunction

BACKGROUND

Pancreatitis associated with pancreaticobiliary maljunction (PBM) is commonly treated nonoperatively before surgery. It is, however, sometimes uncontrollable, and little has been reported about the management.

METHODS

Focusing on the preoperative management, we reviewed clinical courses of 4 PBM cases (ages 1 to 7 years old). Each had pancreatitis that was totally resistant to medical treatment and was applied endoscopic sphincterotomy (ES).

RESULTS

The first case underwent percutaneous transhepatic catheter drainage (PTCD) primarily. In spite of daily lavage using the drainage tube for a week, plugs located in the common channel were not removed, and clinical findings were not improved. Therefore, ES followed by removal of protein plugs was performed to improve pancreatitis dramatically. Through this experience, 3 subsequent cases with refractory pancreatitis all underwent successful ES primarily soon after the medical treatments turned out to be ineffective. In all 4 cases, protein plugs were impacted in common channels, and ES could successfully remove the plugs that were impossible to remove by using PTCD. Improved preoperative pancreaticobiliary decompression by ES shortens the duration of recalcitrant acute pancreatitis associated with PBM allowing for a subsequent safe operation.

CONCLUSIONS

Endoscopic sphincterotomy is one of the useful preoperative managements for refractory pancreatitis associated with PBM.

Balloon sphincteroplasty in the management of choledocholithiasis in a 10-week-old infant

The management of common bile duct stones in neonates has not been clearly fully standardized, although percutaneous image-guided washing of the bile duct is generally adopted as the first-line treatment. We report the case of a 10-week-old infant with a choledocholithiasis in whom anterograde sphincter balloon dilation was achieved by combining image-guided access and flexible gastroduodenoscopy. This mini-invasive strategy may be an alternative to surgery in cases of impacted choledocholithiasis resistant to bile duct washing.

Choledocholithiasis in a 4-month-old infant

Cholelithiasis is increasingly being diagnosed in newborns and infants because of the more frequent use of abdominal ultrasound. However, common bile duct stones causing obstruction or symptoms in infancy are exceedingly rare and are not often reported in the literature. We report the successful treatment of symptomatic choledocholithiasis in a 4-month-old patient with endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy.

Choledocholithiasis in an infant of extremely low birthweight

A five-month-old infant of extremely low birthweight with choledocholithiasis is reported. A baby girl was delivered at 26 weeks gestation as a second twin, weighing 834 g. At 30 days of age, gallbladder stones were found by routine ultrasonography. She had vomiting at 157 days of age. Ultrasonography revealed calculi in the gallbladder and a dilated common bile duct. She was conservatively treated with scopolamine, antibiotics and dehydrocholic and ursodeoxycholic acids, and the calculi had disappeared by 189 days of age. Although conservative treatment succeeded in this patient, further cases should be analysed to establish how to manage choledocholithiasis in such small infants.