Laparoscopic common bile duct exploration in infants with inspissated bile syndrome and choledocholithiasis: A case series

Abstract

Introduction: Inspissated bile syndrome and choledocholithiasis are rare causes of obstructive jaundice in neonates. Laparoscopic common bile duct exploration (LCBDE) is a method for clearing the common bile duct employed in adults and older children but is rarely reported in neonates. Case presentation: We present a case series of 3 infants who underwent LCBDE in the setting of inspissated bile syndrome and/or choledocholithiasis. LCBDE was utilized to power flush the inspissated bile/choledocholithiasis and was successful. Patient 1 was noted to have a dilated common bile duct (CBD) in the setting of inspissated bile. A glidewire was utilized to gain access to the common bile duct via micropuncture needle through the abdominal wall directly into the gallbladder to allow for distal power flushing resulting in successful clearance of the duct noted by repeat cholangiogram. Patient 2 presented with elevated LFTs and dilated CBD with unclear etiology. In a similar fashion to patient 1, access was gained via wire to allow for power flushing resulting in duct clearance. Patient 3, presented with choledocholithiasis and wire access was obtained, however this time via a transcystic ductotomy with a catheter able to be directed to the common bile duct for distal power flushing resulting in duct clearance. Conclusion: These cases highlight the convergence of techniques and equipment gleaned from other types of procedures and indications that allowed us to tailor the surgical approach for definitive clearance of the biliary system. Level of evidence: IV.

Keywords

• search terms
• Laparoscopic common bile duct exploration
• Neonate
• Gallbladder
• Cholestasis
• Obstructive jaundice