Dirk Schaper, I.M. Szargan (St.Barbara-Krankenhaus Halle Kinderchirurgie)  

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14 Years  

Female  

Abdomen-Other and unknown  

other  

14 year old girl with acute abdominal distress. Clinically, chemically and sonographically developed inflammatory process in the lower abdomen. Sonographic representation of the massively infectious appendix.

Intraoperatively, diffuse peritonitis with perforated appendicitis. Antibiotic treatment with Ceftriaxone, as well as others. In the sonographic follow-ups, representation of the noticeable pathology.  

N/A  

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<- view Ultrasound 1

Ultrasound 1: Upper abdomen (longitudinal) in the medial clavicular line: Gall bladder not well-filled, multiple, low-echo, detrital-like concrements.

 

Imaging including endoscopy  

Gallstones, sluge of other genesis.  

In the follow-up examination 14 days after the last dose of ceftriaxone, the pseudolithiasis was gone. The patient felt fine, in regards to the gall bladder.  

The prevalence of gall stones in childhood is low. Increasingly more often, gall bladder sludge development is seen sonographically. Either through totally parenteral nutrition or short-bowel syndrome, precipitations of this type are usually only temporarily proven. In selected cases, however, they can be the origin of stone formation.

In the case of an antibiotic treatment with ceftriaxone, it is recommended to look for such precipitations and to document their course. A surgical indication is usually not given. In our experience, sludge formation when using ceftriaxone is usually temporary. Even by giving this medication intravenously (short-infusion), we have seen this phenonemon. We have not seen a nephrolithiasis as described by de Moor et al..  

Schaad UB, Tschaeppeler H, Lentze MJ
Transient formation of precipitations in the gallbladder associated with Ceftriaxon therapy.
Pediatr Infect Dis J 1986; 5:708  

1. Medline:
Palanduz A, Yalcin I, Tonguc E, Guler N, Ones U, Salman N, Somer A
Sonographic assessment of ceftriaxone-associated biliary pseudolithiasis in children.
J Clin Ultrasound. 2000 May;28(4):166-8

2. Medline:
Schaad UB, Wedgwood-Krucko J, Tschaeppeler H
Reversible Ceftriaxon-associated biliary pseudolithiasis in children.
Lancet II. 1988 :1411-1413

3. Medline:
de Moor RA, Egberts AC, Schroder CH
Ceftriaxone-associated nephrolithiasis and biliary pseudolithiasis.
Eur J Pediatr. 1999 Dec;158(12):975-7.  

Gall bladder concrement, gall bladder sludge, reversible, Ceftriaxone associated, biliary pseudolithiasis, cholelithiasis, cholecystolithiasis, child, childhood, pediatric radiology  

Dirk Schaper, IM Szargan. Reversible Ceftriaxone Associated Biliary Pseudolithiasis. PedRad [serial online] vol 4, no. 4.
URL: www.PedRad.info/?search=20040401105459