TheFetus.net

Gallstones

Philippe Deblieck, MD

Article Published: Feb 22, 2011

Germany

Case report 1

This is a case of multiple echogenic foci in the fetal gallbladder diagnosed at 37 weeks of gestation. No other anomalies were detected. The baby was born at 40 weeks. A postnatal scan performed 3 days after delivery confirmed the diagnosis. The child had no sign of cholestasis and the echogenic foci resolved spontaneously after two weeks.

It is the sixth case observed in our private practice in the last five years.

Video: 37 weeks, video shows the echogenic content of the gallbladder.

Prevalence

During a three-year period (2006-2009) we conducted a prospective study in 862 unselected pregnancies in order to evaluate the prevalence of gallstones or sludge in normal fetuses. The patients were examined with two GE Ultrasound machines (Voluson 730 ProV, Voluson E6).

Examination of the gallbladder was performed as a part of the third trimester screening, between the 29-32 weeks of gestation or later on.

Echogenicities with or without acoustic shadowing within the fetal gallbladder were considered as an echogenic gallbladder contents. We were able to detect the gallbladder in 839 patients of 862 (97.3%).

Sludge or gallstones were found in five fetuses (0,58 %). In all cases, there was no positive family history and no other anomalies were detected except of one newborn with interposition of the large intestine loop between the diaphragm and the liver (*).

Table 1: Cases of the gallstones diagnosed prenatally.

Case (No.) Age (years) Parity Ultrasound (weeks) Delivery (weeks) Birth weight (grams) Sex Findings after delivery (Ultrasound) 1 40 G1P0 39 41 3420 F Chilaiditi sign* 2 28 G2P1 31 39 3220 F Calculi 3 30 G2P1 32 41 3850 M normal 4 32 G1P0 31 40 3350 M not performed 5 42 G4P3 30 40 3220 F normal Images 1-5: Images show the prenatally diagnosed cases of the gallstones which are included in the Table 1 above.
Gallstone_Deblieck_1
Gallstone_Deblieck_2
Gallstone_Deblieck_3
Gallstone_Deblieck_4
Gallstone_Deblieck_5



Review of the literature

Source: Medline
Searched terms: gallstones, fetal, cholelithiasis

Authors Population Echogenic foci
(No of cases)		 Incidence
Wendtland-Born et al.1997(6) Unselected newborns 19/3500 0.5%
Kiserud et al. 1997(7) High risk pregnancies <28 weeks: 0/1133
>28 weeks: 6/523*		 -
1.14%
Agnifili et al. 1998 (8) Third trimester (routine) 3 / 764 0.39%
Müller et al. 2000 (4) Third trimester (high risk) 1 / 1495 0.07%
Candela et al. 2004 (5) Third trimester (routine) 42/9235 0.45%
*associated anomalies: placental hematoma and IUGR, Down and AVSD, Fallot, gallbladder distention, translocation t(10;11)(q22;q22),gastroschisis


Pathophysiology

The incidence and the chemical nature of gallstones in sheep fetuses was investigated by Wood (1) at the King’s College in London. He found gallstones in 50% of the removed  fetal gallbladders. These stones were composed of calcium palmitate and pigment. These findings are in a marked contrast with a low incidence of gallstone in adult sheep (1.75 %) and 0 % in lambs less than 8 months old. This suggests that stones can be formed in the physiological "in utero" conditions and that they subsequently disappear, either dissolve or pass via biliary ducts as in the case of humans ( 2 ).

The first two cases of gallstones in the human fetus were cited by Potter (1928). Haffajee (3 ) examined gallbladders in human fetuses by microdissection (14 in the first trimester, 65 in the second trimester and 10 in the third trimester). He found mucus-like debris and a small solitary crystals in the last group.
The explanation of prenatal formation of gallstones requires extensive chemical and physiological studies.  The complications are very rare and, in the most series, gallstones disappear spontaneously. One case of a laparoscopic cholecystectomy in a 16-day-old infant was reported (32).

References:

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2. Dworken, H.J ( 1960 ).Recent experiences with spontaneously disappearing gallstones. Gastroenterology 38,76
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