When it can be useful look to gallbladder: 2 clinical cases

Abstract

D.A.N. 6 years old, comes to our attention for vomiting and fever. The laboratory investigations show neutrophilic leukocytosis and increased inflammatory markers. She starts intravenous rehydration and antibiotic (Ceftriaxone) therapy with resolution of symptoms after 2 days when diarrhea appears. The third day ultrasound abdomen shows gallbladder contracted with content characterized by biliary sludge collected in a shadow back. She starts UDCA therapy. The new control after about a month of therapy shows complete resolution. Diagnosis: pharmacological pseudogallstones (Ceftriaxone therapy). D.S.F. 5 years old, comes to our observation for uncontrollable vomiting, fever and diarrhea. The laboratory investigations show neutrophilic leukocytosis, elevated lever-associated enzymes and inflammatory markers. Ultrasound abdomen shows cholecystitis with accumulation of biliary sludge in the sloping with acute adenomesenteritis. Diagnosis: acute cholecystitis in adenomesenteritis. Antibiotic and UDCA therapy led to complete remission of symptoms. Gallstones in children is rare (incidence between 0.15% and 0.22%), and often begins with acute cholecystitis. The biliary sludge does not necessarily comes before a calcoluos disease. The treatment with UDCA, however, is useful in resolution of symptoms and it can prevent the formation of calculous. The pseudogallstones has an incidence of 25–40% of patients with antibiotic therapy. It has a spontaneous resolution after discontinuation of therapy, which usually it can be seen from two weeks to five months from interruption.