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Abstract

Background: Primary CBD calculi in infants can be due to primary biliary disease, but are commonly due to distal obstruction & stasis due to choledochal cyst. Undetected, untreated cases may end up with recurrent cholangitis and malignancy later. In this case series, we have discussed about better treatment plan for patients presenting with such symptoms.
Aim: To study the management of CBD calculi in Infants.
Methods: Patients with diagnosis-of Common Bile Duct stones were studied. Four male-patients aged 6 mths to 12 months were studied. Patients  presented with excessive-crying due to pain-abdomen and Jaundice. Two patients had an episodes of cholangitis earlier. The children underwent-investigations to look for hemolytic-anemia, Hb-electrophoresis, liver Function Tests, etc.
Results: These children had high-direct-bilirubin levels and high alkaline-phosphate-levels, radiological studies suggested dilated-CBD with Calculi. They underwent surgical-exploration, where dilated Common-Bile-Duct were found and cholangiography was-done, which showed-obstruction at distal-end with filling defects. The infants underwent-excision of dilated Common-Bile-Duct and Hepatico-jejunostomy. Histopathology reveale-choledochal-cyst in three patients. Postoperative-course was uneventful except in one pt who had biliary leak. All patients are doing well in a follow-up period of 1-year.
Conclusion: There seems to be a thin line separating diagnosis of primary choledocholithiasis and choledochal cyst(CDC). The choledocholithiasis has various treatment modalities but if it is CDC, the other the common-cause of CBD-dilatation and calculi which is an anatomical aberration warrants surgical excision & reconstruction which seems an exaggeration but treatment of choice gives them relief from obstructive jaundice and its sequelae.