# Neonatal Choledocholithiasis: A Rare but Challenging Surgical Scenario

## TL;DR

Neonatal choledocholithiasis is rare and hard to treat, requiring open surgery since ERCP is not feasible in infants.

## Contribution

The paper presents two neonatal cases of choledocholithiasis managed with open surgery due to ERCP limitations.

## Key findings

- ERCP is not feasible in neonates due to small bile ducts and lack of appropriate endoscopes.
- Open surgery with hepaticojejunostomy was effective for managing biliary stones in neonates.
- Improved guidelines and endoscopic options are needed for neonatal choledocholithiasis.

## Abstract

Choledocholithiasis is a rare diagnosis in neonates, and there are no standard management guidelines for this population. Additionally, endoscopic retrograde cholangiopancreatography (ERCP) is often not an option due to the small size of the common bile duct and non-availability of appropriately sized neonatal endoscopes. We present the cases of two neonates with choledocholithiasis. Both patients underwent open cholecystectomy with common bile duct exploration. The biliary stones were not removable, and therefore both underwent a Roux-en-Y hepaticojejunostomy. Both neonates have done well postoperatively. While hyperbilirubinemia is common in neonates, choledocholithiasis is challenging to diagnose. Diagnosis requires a broad differential and the use of abdominal ultrasound. While ERCP is the gold standard in adults, it is difficult to perform in neonates. Therefore, other treatment modalities involving laparoscopic and open surgery may be necessary. There is a need for improved management guidelines and endoscopic treatment options for neonates with choledocholithiasis.