Biliary lithiasis

What is biliary lithiasis?

This involves the presence of stones in the gallbladder and in the intra and extra-hepatic bile ducts (inside and outside of the liver).

What are the causes?

The origin of the biliary lithiasis in a child is found in only 30% of cases. Sometimes it is due to excess cholesterol in the blood. 
It occurs more often in certain chronic diseases, for example hemolytic blood diseases, through prolonged parenteral nutrition, or by extensive resections of the small intestine.

What are the symptoms?

Biliary lithiasis is often asymptomatic and is only accidentally detected during an abdominal ultrasound scan. However, it can cause abdominal pain, called "biliary colic."
Two major complications are acute cholecystitis (inflammation of the gallbladder) and gallstone migration into the main bile duct with a risk of biliary retention (associated with jaundice) or pancreatitis (inflammation of the pancreas).

How is it diagnosed?

An abdominal ultrasound scan allows for a diagnosis and this can be supplemented by magnetic resonance cholangiopancreatography (cholangio-MRI).
A blood test is also performed in addition to the imaging to find the origin of the lithiasis and of any irritation in the liver and/or pancreas.

What are the treatments?

Biliary lithiasis is asymptomatic, with no known cause, and is simply monitored because spontaneous disappearance of the disease is possible.
Biliary lithiasis that is symptomatic or secondary to chronic hemolysis (destruction of red blood cells with anemia, such as in cases of sickle cell disease or spherocytosis), requires surgical treatment, which consists of removing the gall bladder via laparoscopy.

A cholangiogram (visualization of the bile ducts) is often performed during surgery to eliminate a stone that is "stuck" in the bile duct.
In infants, percutaneous cholangiography often clears the bile duct of obstructed stones, but sometimes a laparotomy must be performed.