Biliary Lithiasis Associated with the Use of Ceftriaxone for Gastroenteritis in Children: Case Report and Literature Review

Carlos Teixeira Brandt, Maria Cecilia Santos Cavalcanti Melo, Monize Naara Lourenço de Morais Soares and Daniella Bandin Cruz

Department of Pediatric Surgery, Olinda Medical School, Brazil

^*Correspondance to: Carlos Teixeira Brandt 

 PDF  Full Text DOI: 10.25107/2474-1647.1455

Abstract

Obejective: Ceftriaxone is used for the treatment of gastroenteritis in children when hospitalized, with the possible complication of cholelithiasis in the first days of administration of this antimicrobial. The handling of this side effect remains discordant among surgeons. The present report aims at showing different views between two pediatric surgeons and questions the weight of evidence among the proposed approaches.Case
Presentation: MSAS, white female, age of 3.5 years admitted to hospital for gastroenteritis and dehydration. In the therapeutic prescription there was inclusion of ceftriaxone. After three days, the child healed the gastroenteritis. However, she began to present abdominal pain that required analgesic and antispasmodic. Abdomen ultrasound revealed the presence of multiple bile stones with an average size of 0.4 cm. In the follow-up, abdominal pain became more frequent and intense. After 10 days of hospital discharge, new ultrasound showed the presence of an echogenic image measuring 1.5 cm, compatible with bile stone. The presumption was that cholelithiasis would be related to the use of ceftriaxone. The opinions of pediatric surgeons differed as to the need for emergency cholecystectomy. Significant and persistent abdominal pain continued. Follow-up ultrasound evidenced a change in the aspect of the bile stone, passing from the multilobulated aspect suggesting compact bile conglomerate. In the latter ultrasound, three small bile stones were observed, the largest one measuring 0.3 cm (“pseudo biliary lithiasis”). The argument of one of the surgeons that this situation was more serious, because it added the possibility of producing jaundice or pancreatitis weighed on the parents’ acceptance of cholecystectomy. The child underwent surgery without complications and the evolution was satisfactory.Discussion: The management of pseudo biliary lithiasis due to ceftriaxone is still controversial and additional evidence is required for gold standard conduct in the resolution of these cases. Postcholecystectomy syndrome needs to be included in this decision-making process.

Keywords

Ceftriaxone; Biliary lithiasis; Pseudolithiasis; Post-cholecystectomy syndrome; Children

Cite the article

Brandt CT, Melo MCSC, de Morais Soares MNL, Cruz DB. Biliary Lithiasis Associated with the Use of Ceftriaxone for Gastroenteritis in Children: Case Report and Literature Review. Clin Surg. 2017; 2: 1455.