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Poster - 295
Choledocholithiasis in children: evaluating the efficacy of expectant strategies
Senda Houidi, Fatma Thamri, Oussema Meherzi, Arije Zouaoui, Yosra Kerkeni, Sondes Sahli, Riadh Jouini
children hospital Bechir Hamza, Pediatric surgery department A Tunis Tunisia
Introduction:
Choledocholithiasis, the presence of gallstones in the common bile duct (CBD), is a rare yet serious condition in pediatric patients. The optimal management strategy is still a subject of debate. Our purpose is to examine the natural history of choledocholithiasis in children in an attempt to provide guidelines for its management.
Methods:
This retrospective study reviewed the medical records of all children diagnosed with choledocholithiasis from 2003 to 2023. Data collected included patient demographics, clinical presentation, diagnostic methods, management approaches, postoperative outcomes. Patients were categorized into those managed conservatively and those undergoing ERCP. Outcomes were assessed based on symptom resolution, complication rates, and recurrence during follow-up.
Results:
A total of 12 children with choledocholithiasis were identified, with a mean age of 8.9 ± 1.6 years. Clinical presentations included abdominal pain in 91.7%, obstructive jaundice in 75%, and fever in 58.3%. Seven patients (58.3%) were diagnosed with choledocholithiasis as a distinct entity, with 5 of these (71.4%) presenting with acute pancreatitis, which was the primary clinical manifestation leading to further investigation. The remaining 46.7% of cases corresponded to retained CBD stones in patients previously cholecystectomized. Management strategies included conservative treatment in 11 patients (91.7%), which involved close monitoring and supportive care, and combined ERCP in one patient. Among those managed conservatively, 10 children (91%) achieved spontaneous resolution of symptoms and demonstrated sonographic resolution within 1 week without the need for invasive procedures. No recurrences of choledocholithiasis were observed in either group during the follow-up period of 24 months.
Conclusion:
Our findings suggest that the natural history of choledocholithiasis in children may support expectant management strategies as there is a high likelihood of spontaneous passage of stones through the papilla and subsequent resolution of symptoms without the need for invasive procedures.