Bile thickening syndrome in newborns and young children: risk factors, therapy, prognosis. А clinical case study

Abstract

Bile thickening syndrome or biliary sludge causing obstruction of the common bile duct and impaired passage of bile into the duodenum ranks second among “surgical jaundice” in newborns and young children. The syndrome should be diagnosed early to conduct timely conservative treatment to avoid surgical intervention and complications such as acute pancreatitis, acute cholecystitis, cholelithiasis. Risk factors for bile thickening syndrome include prematurity, extremely low birth weight, long term parenteral nutrition, administration of diuretics, third generation cephalosporins. If a threat of biliary sludge arises, repeat abdominal ultrasound imaging and identification of the following signs of this syndrome are indicated: dilatation of CBD more than 3 mm, the presence of heterogeneous sediment in the gallbladder and common bile duct. The article presents a clinical discussion of a bile thickening syndrome case in a an extremely low birth weight girl born at 29 weeks’ gestational age. The condition of the newborn at birth was very severe. The severity of the condition was caused by the type 1 respiratory distress syndrome, the girl was immediately intubated and mechanically ventilated. At the age of 1 month 10 days, the girl was transferred from the intensive care unit to the neonatal unit. The ultrasonic imaging showed an oval-shaped gallbladder of 26 x 6 mm in size, 0.5 ml in volume, instable angulation of the gallbladder body and neck, the walls of up to 2 mm in thickness, laminated, hyperechogenic, hyperechoic contents in the lumen (ointment-like bile), which allowed to draw a conclusion about the presence of bile thickening syndrome. Ursodeoxycholic acid at a dose of 20 mg/kg/day was prescribed immediately after ultrasonic imaging. 10 days later the dose of the drug was increased to 30 mg/kg/day. Two weeks later, the child was discharged home in satisfactory condition without signs of bile thickening syndrome. Knowledge of the risk factors for biliary sludge makes it possible to assign timely instrumental examination, establish early diagnosis and prescribe conservative therapy, and exclude surgical methods of treatment.