Subinay Mandal1, Meghdeep Mukhopadhyay2, Prasant Agarwal3

The first prenatal diagnosis of cholelithiasis was done by Beretsky and Lankin in 1983. Foetal cholelithiasis is a rare finding during a third trimester of pregnancy. Despite the remarkable number of foetal scans performed annually worldwide, little is known about the pathogenesis and outcome of foetal cholelithiasis. We present the outcome of neonates with clinical and sonographic followup.
We retrospectively analysed the data of neonates born between the periods of January 2012 to December 2016 in a tertiary hospital, diagnosed prenatally having echogenic material in the foetal gallbladder. Detailed maternal, medical, obstetric and foetal health was analysed. Follow up ultrasonographic and clinical findings till resolution of the echogenic foci were noted in the postnatal period. Postnatal complications of the neonate if any were also noted.
Over last five years, we detected 17 neonates with foetal diagnoses of echogenic focus in the gallbladder. Girl babies were affected more (58.8%). 64.7% cases were detected after 30 weeks of gestation. Mean gestational age of prenatal detection of echogenic foci was 34 weeks. Maternal obstetric complications associated with the cases were polyhydramnios, oligohydramnios, preeclamptic toxaemia and antepartum haemorrhage. Maternal medical illnesses were E-beta thalassaemia, gestational diabetes mellitus and hypothyroidism. Foetal and neonatal complications were prematurity, congenital anomaly (choledochal cyst), chromosomal anomaly (Down’s syndrome), polycythaemia, sepsis, neonatal hepatitis and haemolytic conditions. On follow-up, in 76.5% cases, resolution of echogenic material occurred within two months of postnatal age. There was persistence of echogenic material in 23.5% cases.
Biliary sludge and gallstones are uncommon in foetal life. The aetiopathogenesis of foetal cholelithiasis is currently unknown. Though, different maternal, obstetric and foetal predisposing risk factors are found to be associated, but there are no established correlations. In most of the cases, foetal cholelithiasis resolves spontaneously. Considering its high rate of spontaneous resolution, we recommend reassuring parents and closely observing the clinical evolution of the patients. However, it needs to be differentiated from the sinister pathologies and requires accurate diagnosis.