Journal of Regional Section of Serbian Medical Association in Zajecar
Year 2003     Volumen 28     Number 3-4
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UDK 616. 366-0037-053.2  ISSN 0350-2899, 28(2003) 3-4 p.71-74
Original paper

Biliary pseudolithiasis in childhood

Gavrilo Vasilev, Milorad Micović, Marica Nastasijević
Radiološka služba, Pedijatrijska služba, Zdravstveni centar Kladovo

Reversible precipitates in the gall bladder during and after ceftriaxon therapy is neither rare nor unknown phenomenon. 1988 Schaad called it “Biliary pseudolithasis” and described the precipitation phenomenon. Knowing this, we were provoked to do prospective study dealing with this problem. Between XII 2000 and XII 2002, 88 paediatric patients who who had antibiotic therapy were prospectively examined by serial abdominal ultrasonography. First graup of 43 children were treated with ceftriaxon (administered intravenously or intramuscularly in daily single dose of 50mg/kg under 2 g/day). The other group of 45 children were treated with some other antibiotics in a proper dose and adequate application. In both groups the mean duration of antibiotic therapy was approximately 10 days. Serial abdominal ultrasonography were performed after 1st, 2nd, 5th and the last dose of antibiotic. Reversible biliary pseudolithiasis was detected only in the children treated with ceftriaxon in 25,58 % of cases (11 from 42 vs 0 from 45). Most were asymptomatic, but in 2 cases children felt pain at the right upper abdominal quadrant and one child repoted vomiting. Two of the eleven “biliary pseudolithiasis” appeared after the first dose, five after the fifth dose, and four appeared after the last dose. After finishing with the therapy we examined “pseudolithiasis“ in every 7 days. Ultrasonographical abnormalities and symptoms disappeared spontaneously and completely sonographic resolved after 1-8 weeks. Appearance of “biliary pseudolithiasis“ and completely spontsneous resolve seem independent of the age, sex, the nature of the diseases, dose and duration of therapy. Clinicians and radiologists should be aware of this complication and prevent unnecessary cholecystectomy. The antibacterial and pharmacokinrtic benefits of ceftriaxone prevails over the problem of reversible biliary pseudolithiasis.
Key words: biliary pseudolithiasis, ultrasonography, ceftriaxon
  Correspodence to:
Gavrilo Vasilev
Dunavska D4 II/15, 19320 Kladovo
Serbia and Montenegro
  Received: 8. V 2003.
Accepted: 2. IX 2003.
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