Barzilai M
Radiology Dept., Carmel Medical Center, Haifa.
Harefuah. 1994 Sep;127(5-6):163-5, 215.
The term biliary pseudolithiasis was coined by Schaad (1988) to describe the appearance of gallbladder sludge following treatment with ceftriaxone. After cessation of the drug the condition resolves, hence the term "pseudolithiasis." The third generation cephalosporin, cefatriaxone, is a very potent, broad spectrum antibiotic indicated in meningitis, osteomyelitis, pyelonephritis, Lyme disease and many other severe infectious diseases. Up to 46% of those receiving this antibiotic develop gallbladder sludge. Most are asymptomatic, but a small proportion may develop right upper quadrant pain, nausea, vomiting and even cholecystitis. Ultrasonography may demonstrate many, small, echogenic particles within the gallbladder, as well as larger echogenic foci casting acoustic shadows. However, it can not differentiate these pseudostones from real stones. There are reports of surgical intervention in such cases. 2 boys, aged 5 and 10 years, respectively, treated with ceftriaxone for meningitis are presented. Both developed symptoms during treatment and in both gallbladder sludge was identified by ultrasonography. In 1 intraluminal gallbladder findings were identical with the appearance of surgical stones. Follow-up ultrasonography after the drug was stopped showed no evidence of pseudostones in either case. Awareness of this phenomena might save many unnecessary operations.
“胆汁假性结石症”这一术语由沙德（1988年）提出，用于描述头孢曲松治疗后胆囊内出现的胆泥表现。停药后这种情况会自行缓解，因此有了“假性结石症”这个术语。第三代头孢菌素头孢曲松是一种非常强效的广谱抗生素，用于治疗脑膜炎、骨髓炎、肾盂肾炎、莱姆病和许多其他严重传染病。接受这种抗生素治疗的患者中，高达46%会出现胆囊胆泥。大多数人没有症状，但一小部分人可能会出现右上腹疼痛、恶心、呕吐，甚至胆囊炎。超声检查可能会显示胆囊内有许多小的回声颗粒，以及较大的回声灶并伴有声影。然而，它无法将这些假结石与真正的结石区分开来。有报道称对此类病例进行了手术干预。本文介绍了2名分别为5岁和10岁的男孩，他们因脑膜炎接受头孢曲松治疗。两人在治疗期间均出现症状，超声检查均发现胆囊胆泥。其中1例胆囊腔内的表现与手术结石的外观相同。停药后的随访超声检查显示，两例均未发现假结石迹象。认识到这种现象可能会避免许多不必要的手术。
