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2011-02-22-09 Gallstones © Deblieck www.TheFetus.net

Gallstones


Philippe Deblieck, MD
. 

Germany


Case report 1

This is a case of multiple echogenic foci in the fetal gallbladder diagnosed at 37 weeks of gestation. No other anomalies were detected. The baby was born at 40 weeks. A postnatal scan performed 3 days after delivery confirmed the diagnosis. The child had no sign of cholestasis and the echogenic foci resolved spontaneously after two weeks.
It is the sixth case observed in our private practice in the last five years.

Video: 37 weeks, video shows the echogenic content of the gallbladder.




Prevalence


During a three-year period (2006-2009) we conducted a prospective study in 862 unselected pregnancies in order to evaluate the prevalence of gallstones or sludge in normal fetuses. The patients were examined with two GE Ultrasound machines (Voluson 730 ProV, Voluson E6).
Examination of the gallbladder was performed as a part of the third trimester screening, between the 29-32 weeks of gestation or later on.
Echogenicities with or without acoustic shadowing within the fetal gallbladder were considered as an echogenic gallbladder contents. We were able to detect the gallbladder in 839 patients of 862 (97.3%).

Sludge or gallstones were found in five fetuses (0,58 %). In all cases, there was no positive family history and no other anomalies were detected except of one newborn with interposition of the large intestine loop between the diaphragm and the liver (*).

Table 1
: Cases of the gallstones diagnosed prenatally.

Case
(No.)
Age
(years)
Parity Ultrasound
(weeks)
Delivery
(weeks)
Birth weight
(grams)
Sex Findings after delivery
(Ultrasound)
1 40 G1P0 39 41 3420 F Chilaiditi sign*
2 28 G2P1 31 39 3220 F Calculi
3 30 G2P1 32 41 3850 M normal
4 32 G1P0 31 40 3350 M not performed
5 42 G4P3 30 40 3220 F normal


Images 1-5
: Images show the prenatally diagnosed cases of the gallstones which are included in the Table 1 above.








Review of the literature

Source: Medline
Searched terms: gallstones, fetal, cholelithiasis

Authors Population Echogenic foci
(No of cases)
Incidence
Wendtland-Born et al.1997(6) Unselected newborns 19/3500 0.5%
Kiserud et al. 1997(7) High risk pregnancies <28 weeks: 0/1133
>28 weeks: 6/523*
-
1.14%
Agnifili et al. 1998 (8) Third trimester (routine) 3 / 764 0.39%
Müller et al. 2000 (4) Third trimester (high risk) 1 / 1495 0.07%
Candela et al. 2004 (5) Third trimester (routine) 42/9235 0.45%
*associated anomalies: placental hematoma and IUGR, Down and AVSD, Fallot, gallbladder distention, translocation t(10;11)(q22;q22),gastroschisis


Pathophysiology

The incidence and the chemical nature of gallstones in sheep fetuses was investigated by Wood (1) at the King’s College in London. He found gallstones in 50% of the removed  fetal gallbladders. These stones were composed of calcium palmitate and pigment. These findings are in a marked contrast with a low incidence of gallstone in adult sheep (1.75 %) and 0 % in lambs less than 8 months old. This suggests that stones can be formed in the physiological "in utero" conditions and that they subsequently disappear, either dissolve or pass via biliary ducts as in the case of humans ( 2 ).

The first two cases of gallstones in the human fetus were cited by Potter (1928). Haffajee (3 ) examined gallbladders in human fetuses by microdissection (14 in the first trimester, 65 in the second trimester and 10 in the third trimester). He found mucus-like debris and a small solitary crystals in the last group.
The explanation of prenatal formation of gallstones requires extensive chemical and physiological studies.  The complications are very rare and, in the most series, gallstones disappear spontaneously. One case of a laparoscopic cholecystectomy in a 16-day-old infant was reported (32).

References:

1. Potter, A.H. ( 1928 ).Gallbladder disease in young subjects. Surgery, Gynecology and Obstetrics 46, 795
2. Dworken, H.J ( 1960 ).Recent experiences with spontaneously disappearing gallstones. Gastroenterology 38,76
3. Haffajee MR. The fetal gallbladder: morphology and morphometry by microdissection. Surg Radiol Anat. 2000;22(5-6):261-70. PubMed PMID:11236320.
4. Müller R, Döhmann S, Kordts U. [Fetal gallbladder and gallstones]. Ultraschall Med. 2000 Jun;21(3):142-4. German. PubMed PMID: 10929602.
5. Cancho Candela R, Díaz González J, Perandones Fernández C, Viñuela Rueda B, Relea Sarabia A, Andrés de Llano JM. [Echogenic material in fetal gallbladder:prenatal diagnosis and postnatal follow-up]. An Pediatr (Barc). 2004  Oct;61(4):326-9. Spanish. PubMed PMID: 15456588.
6. Wendtland-Born A. et al., Prävalenz von Gallensteinen in der Neugeborenenperiode, Ultraschall in Med.18 (1997) 80-83
7. Kiserud T. et al.,echogenic material in the fetal gallbladder and fetal disease, Ultrasound Obstet.Gynecol. 10 (1997) 103-106
8. Agnifili A, Mancini E, Palermo P, Gola P, Carducci G, Marino M, Ibi I, Caterino G, Rizzo FM. [Prospective research on fetal cholelithiasis: incidence,
predisposing conditions, echographic diagnosis, and clinical features]. G Chir. 1998 Aug-Sep;19(8-9):329-33. Review. Italian. PubMed PMID: 9734183.
9. Nishi T. Ultrasonographic diagnosis of fetal cholelithiasis. J Obstet Gynaecol Res. 1997 Jun;23(3):251-4. PubMed PMID: 9255037.
10. Agnifili A, Carducci A, Biasini G, Gola P, Marino M, Verzaro R, Carducci G, Mancini E, Rizzo FM. [Fetal biliary lithiasis: ultrasonographic diagnosis and
clinical interpretation. Report of 3 cases]. Radiol Med. 1997 Apr;93(4):401-4. Italian. PubMed PMID: 9244918.
11. Stringer MD, Lim P, Cave M, Martinez D, Lilford RJ. Fetal gallstones. J Pediatr Surg. 1996 Nov;31(11):1589-91. Review. PubMed PMID: 8943134.
12. Petrikovsky B, Klein V, Holsten N. Sludge in fetal gallbladder: natural history and neonatal outcome. Br J Radiol. 1996 Nov;69(827):1017-8. PubMed PMID: 8958018.
13. Sepulveda W, Stagiannis KD. Echogenic material in the fetal gallbladder in a surviving monochorionic twin. Pediatr Radiol. 1996;26(2):129-30. PubMed PMID:8587812.
14. Petrikovsky B, Klein VR. Cholecystomegaly and fetal gallstones. Prenat Diagn.1995 Sep;15(9):875. PubMed PMID: 8559762.
15. Clarke JP, Roman JD. The outcome of two cases of fetal cholelithiasis. N Z Med J. 1994 Jul 13;107(981):270. PubMed PMID: 8022584.
16. Debray D, Pariente D, Gauthier F, Myara A, Bernard O. Cholelithiasis in infancy: a study of 40 cases. J Pediatr. 1993 Mar;122(3):385-91. PubMed PMID: 8441092.
17. Suchet IB, Labatte MF, Dyck CS, Salgado LA. Fetal cholelithiasis: a case report and review of the literature. J Clin Ultrasound. 1993 Mar-Apr;21(3):198-202. Review. PubMed PMID: 8382223.
18. Devonald KJ, Ellwood DA, Colditz PB. The variable appearances of fetal gallstones. J Ultrasound Med. 1992 Nov;11(11):579-85. PubMed PMID: 1433465.
19. Aughton DJ, Gibson P, Cacciarelli A. Cholelithiasis in infants with Down syndrome. Three cases and literature review. Clin Pediatr (Phila). 1992
Nov;31(11):650-2. Review. PubMed PMID: 1424392.
20. Brown DL, Teele RL, Doubilet PM, DiSalvo DN, Benson CB, Van Alstyne GA. Echogenic material in the fetal gallbladder: sonographic and clinical
observations. Radiology. 1992 Jan;182(1):73-6. PubMed PMID: 1727312.
21. Abbitt PL, McIlhenny J. Prenatal detection of gallstones. J Clin Ultrasound. 1990 Mar-Apr;18(3):202-4. PubMed PMID: 2155942.
22. Figueroa-Colon R, Tolaymat N, Kao SC. Gallbladder sludge and lithiasis in an infant born to a morphine user mother. J Pediatr Gastroenterol Nutr. 1990 Feb;10(2):234-8. PubMed PMID: 2303975.
23. Broussin B, Daube E. [Fetal cholelithiasis. Apropos of 3 cases and review of the literature]. J Gynecol Obstet Biol Reprod (Paris). 1990;19(1):90-5. Review. French. PubMed PMID: 2179397.
24. Klingensmith WC 3rd, Cioffi-Ragan DT. Fetal gallstones. Radiology. 1988 Apr;167(1):143-4. PubMed PMID: 3279452.
25. Heijne L, Ednay D. The development of fetal gallstones demonstrated by ultrasound. Radiography. 1985 May-Jun;51(597):155-6. PubMed PMID: 3892572.
26. Beretsky I, Lankin DH. Diagnosis of fetal cholelithiasis using real-time high-resolution imaging employing digital detection. J Ultrasound Med. 1983
Aug;2(8):381-3. PubMed PMID: 6887335.
27. Dissolution of gallstones. Nutr Rev. 1973 Apr;31(4):113-4. Review. PubMed PMID: 4578891.
28. Sheiner E, Abramowicz JS, Hershkovitz R. Fetal gallstones detected by routine third trimester ultrasound. Int J Gynaecol Obstet. 2006 Mar;92(3):255-6. Epub 2006 Jan 26. PubMed PMID: 16442535.
29. Munjuluri N, Elgharaby N, Acolet D, Kadir RA. Fetal gallstones. Fetal Diagn Ther. 2005 Jul-Aug;20(4):241-3. PubMed PMID: 15980632.
30. Suma V, Marini A, Bucci N, Toffolutti T, Talenti E. Fetal gallstones: sonographic and clinical observations. Ultrasound Obstet Gynecol. 1998
Dec;12(6):439-41. PubMed PMID: 9918095.
31. Hertzberg BS, Kliewer MA. Fetal gallstones in a contracted gallbladder: potential to simulate hepatic or peritoneal calcification. J Ultrasound Med. 1998
Oct;17(10):667-70. PubMed PMID: 9771612.
32. Gertner M., Farmer D, Laparoscopic cholecystecomy in a 16-day-old infant with chronic cholelithiasis. Journal of Pediatric Surgery. 2004 Jan; 39 (1): 17-19.


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