Cholelithiasis and perforated gallbladder in an infant

An infant presented with abdominal distension and failure to thrive. This patient was a 3.5-month-old, ex-26-week premature infant at the time of presentation who required supplemental parenteral nutrition until day 9 of life. Workup found ascites and a complex cystic mass in the porta hepatis. A perforated gallbladder with gallstones was found at laparotomy. The gallstones were removed, and the bed of the gallbladder was drained. Output from the drain was minimal by postoperative day 6, and the drain subsequently was removed. The child did well postoperatively; hematologic and metabolic workups were unrevealing. Perforation of the gallbladder is an exceedingly uncommon finding in infants. Appropriate management includes laparotomy and drainage of the gallbladder bed.