Persistent Cholelithiasis Following Biochemical Resolution of Parenteral Nutrition-Associated Cholestasis in a Former Preterm Infant: Surgical Management With Open Cholecystectomy
Year: 2026
Type: article
Study design: Case Report
Abstract: Gallstones in early infancy are increasingly detected in survivors of neonatal intensive care, and most contemporary series favor observation because spontaneous resolution is common. Less well described is the divergence that may follow: cholestasis resolves completely while the stones formed during it remain. We present the case of a male infant born at 35 weeks of gestation who required high-frequency oscillatory ventilation, five vasoactive agents for septic shock, and 23 days of parenteral nutrition during a 45-day admission, developing cholestatic liver disease (total bilirubin 11.9 mg/dL, alkaline phosphatase 1,657 U/L). Ultrasonography at 2.8 months showed a cluster of gallstones measuring 9.8 × 5 × 7.4 mm, without cholecystitis or duct dilation. The cholestasis then resolved completely, and growth was restored; at 7.3 months, total bilirubin was 0.15 mg/dL and gamma-glutamyl transferase was 8 U/L. The stones did not resolve, a 6.5 mm calculus persisted at 5.0 months, and the infant remained asymptomatic. After six months of observation, open cholecystectomy was performed at eight months and 26 days of age and 9.1 kg, without complication; a black pigment calculus was recovered, and histopathology showed changes of immaturity without inflammatory infiltrate. He was discharged on the second postoperative day and remained free of biliary symptoms through 102 days. Biochemical recovery of the liver does not predict clearance of established lithiasis, the lithogenic exposures in these infants are multiple and should not be attributed to parenteral nutrition alone, and operating on an asymptomatic infant deserves to be argued explicitly rather than assumed.
Source: Cureus
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7214347237