Conservative Treatment for Cystic Duct Stenosis in a Child

Introduction. Few cases of common bile duct stenosis have been reported in the literature, and observations of strictures in the cystic duct are even more rare. Surgical cholecystectomy is the treatment needed in most cases of gallbladder hydrops. This paper describes the diagnosis and successful medical treatment of a rare pediatric case of cystic duct stenosis and gallbladder hydrops. Case Report. A formerly healthy one-year-old girl was admitted with colicky abdominal pain. Blood tests were normal, except for an increase in transaminases. Abdominal ultrasound excluded intestinal intussusception and identified a distended gallbladder with biliary sludge. MR cholangiography revealed a dilated gallbladder containing bile sediment and no detectable cystic duct, while the rest of the intra- and extrahepatic biliary tree and hepatic parenchyma were normal. This evidence was consistent with gallbladder hydrops associated with cystic duct stenosis. The baby was treated with i.v. hydration, corticosteroids, antibiotics, and ursodeoxycholic acid. Her general condition rapidly improved, with no further episodes of abdominal pain and normalization of liver enzymes. This allowed to avoid cholecystectomy, and the child is well 1.5 years after diagnosis. Conclusions. Although cholecystectomy is usually necessary in case of gallbladder hydrops, our experience suggests that surgical procedures can be avoided when the distension is caused by a cystic duct stenosis. 1. Introduction Acute gallbladder distension (hydrops) is unusual in pediatric age [1, 2]. It may be a consequence of obstruction of the cystic duct caused by gallstones, cholangitis, sclerosing cholangitis, cystic fibrosis [3], congenital or postoperative biliary malformations [4], or benign or malignant lesions [5, 6]. Laparoscopic cholecystectomy is usually warranted [7–10]. There are few reports of stenosis of the common bile duct in the literature, and the observations of strictures located in the cystic duct are even rarer. This paper describes and discusses the diagnostic and therapeutic workup in a child with stenosis of the cystic duct and gallbladder hydrops. 2. Case Report A formerly healthy one-year-old Caucasian girl was admitted with colicky abdominal pain and a history of two episodes of vomiting on the previous day, and a bout of gastroenteritis during the week before, with isonatremic dehydration. On admission, the child’s general condition seemed poor. Her abdomen was distended and diffusely painful, particularly in the middle right quadrant, where a soft mass was detectable. Blood tests