Endoscopic papillosphincterotomy and lithoextraction for choledocholithiasis in an adolescent

Abstract

Choledocholithiasis is rare in the pediatric population, but its incidence has been increasing in recent years. Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic papillosphincterotomy (EPS) and lithoextraction is a minimally invasive technique widely used in adults; however, it is less frequently applied in children and adolescents. A 15-year-old male presented with right upper quadrant abdominal pain, jaundice, and nausea. Laboratory evaluation revealed elevated serum bilirubin and transaminase levels. Abdominal ultrasonography and ERCP demonstrated a 2 cm stone impacted at the Vater’s papilla. EPS followed by lithoextraction was performed successfully without any complications. The patient experienced rapid clinical improvement and was discharged on the third postoperative day. At follow-up, he remained asymptomatic with no evidence of recurrence. ERCP combined with EPS and lithoextraction is a safe, effective, and minimally invasive therapeutic option for the management of choledocholithiasis in adolescents, offering an alternative to open surgical approaches.

Keywords

• Choledocholithiasis
• endoscopic retrograde cholangiopancreatography
• pediatric gastroenterology
• lithoextraction
• case report

Endoskopik papillosphinkterotomi ve litoekstraksiyon ile adölesan dönemde koledokolitiazis tedavisi

Öz

Koledokolitiazis pediatrik yaş grubunda nadir görülür, ancak son yıllarda insidansı artmaktadır. Endoskopik retrograd kolanjiyopankreatografi (ERCP) ile endoskopik papillosphinkterotomi (EPS) ve litoekstraksiyon, erişkinlerde yaygın olarak kullanılan minimal invaziv bir tekniktir; ancak çocuklar ve adölesanlarda daha seyrek uygulanmaktadır. 15 yaşında erkek hasta, sağ üst kadran karın ağrısı, sarılık ve bulantı şikayetleri ile başvurdu. Laboratuvar incelemelerinde serum bilirubin ve transaminaz düzeylerinde artış saptandı. Abdominal ultrasonografi ve ERCP’de Vater papillasında 2 cm’lik taş izlendi. EPS ve ardından litoekstraksiyon komplikasyonsuz bir şekilde uygulandı. Hasta hızlı bir klinik iyileşme gösterdi ve postoperatif üçüncü günde taburcu edildi. Takiplerde asemptomatik seyretti ve nüks gözlenmedi. Adölesanlarda koledokolitiazisin tedavisinde ERCP ile kombine edilen EPS ve litoekstraksiyon, açık cerrahiye alternatif olarak güvenli, etkili ve minimal invaziv bir seçenektir.

Anahtar Kelimeler

• Koledokolitiazis
• endoskopik retrograd kolanjiyopankreatografi
• pediatrik gastroenteroloji
• litoekstraksiyon

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