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Management of choledocholithiasis in an infant

Yu, Peter T. (Children's Hospital of Orange County, Division of Pediatric Surgery, 1201 W La Veta, Orange, CA 92868, USA ) ; Fenton, Stephen J. (Primary Children's Hospital, 100 N Mario Capecchi Drive, Salt Lake City, UT 84113, USA ) ; Delaplain, Patrick T. (Children's Hospital Los Angeles, Division of Surgery, 4650 Sunset Blvd, Los Angeles, CA 90027, USA ) ; Vrecenak, Jesse (The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA ) ; Adzick, N. Scott (The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA ) ; Nance, Michael L. (The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA ) ; Guner, Yigit S. (Children's Hospital of Orange County, Division of Pediatric Surgery, 1201 W La Veta, Orange, CA 92868, USA ) ;
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    Abstract Choledocholithiasis is a rare diagnosis in the infant population with poorly defined optimal management. Endoscopic and operative interventions are both technically challenging. Endoscopic retrograde cholangiopancreatography (ERCP), common bile duct exploration and laparoscopic cholecystectomy are typically safe and successful when performed. However, choledocholithiasis has been reported to spontaneously resolve in up to 60% of cases in neonates and infants. We present five cases of choledocholithiasis in infants and a comprehensive review of the literature. Based on our review and experience, we make a recommendation that clinicians should proceed with a selective approach in the management of this disease based on severity of symptoms, co-morbidities, and the available surgical and endoscopic capabilities of each institution. Highlights Choledocholithiasis in the infant population is a rare occurrence. Proceed with a selective approach taking into account clinical status, age, and size of infants. ERCP can be utilized in infants with choledocholithiasis where expertise is present.


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