Fishman et al reported findings associated with choledocholithiasis in a pediatric patient. Criteria used in adults do not perform as well in a pediatric population. The authors are from multiple institutions in the United States, Australia and Italy.
Patient selection: age < 19 years, suspected choledocholithiasis or gallstone pancreatitis
Exclusion: hemolytic disease
Serum bilirubin: cutoffs were a conjugated/direct bilirubin >= 0.5 mg/dL and total bilirubin >= 1.8 mg/dL. Serum bilirubin measurements did not have high sensitivity for detection.
Transabdominal ultrasonography (US) is often performed. However:
(1) stones found on US may not be seen in ERCP
(2) stones seen on ERCP may not be seen in US
(3) an absolute measure of common bile duct diameter is generally ineffective
(4) a common bile duct diameter >= 2 times the expected diameter may be predictive
The authors recommended MRCP and/or endoscopic US (EUS) in select patients with suspected gallstone pancreatitis or other reasons to suspect choledocholithiasis such as lack of improvement in laboratory values.
To read more or access our algorithms and calculators, please log in or register.
