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Gallstones and common bile duct calculi in infancy and childhood
1Royal Alexandra Hospital for Children (New Children's Hospital), Westmead, New South Wales, Australia.
Insights
Gallstones and common bile duct stones are increasingly diagnosed in children. This study reviewed 102 cases over two decades, noting a rise in idiopathic and hematologic stones.
Area of Science:
- Pediatric Gastroenterology
- Hepatobiliary Surgery
Background:
- Gallstones and common bile duct calculi diagnoses in children have increased.
- A two-decade review of pediatric cases was conducted.
Purpose of the Study:
- To review the spectrum of gallstones and common bile duct calculi in infants and children.
- To analyze etiological factors, clinical presentations, and management outcomes.
Main Methods:
- Retrospective analysis of 102 consecutive pediatric cases diagnosed between 1979-1996.
- Follow-up data collection to assess outcomes.
Main Results:
- Median age at presentation was 10 years; recurrent right upper quadrant pain was most common.
- Idiopathic (66) and hematologic (23) gallstones showed a two-fold increase in incidence.
- Choledocholithiasis (18 cases) occurred more in females and children under 5, presenting with jaundice.
Conclusions:
- Gallstone incidence in children is increasing, often idiopathic and presenting with vague pain.
- Choledocholithiasis is significant in pediatric patients, particularly girls under 5, often presenting with jaundice.
Background:
Gallstones and common bile duct calculi have been increasingly diagnosed in recent years in infants and children. The present study aims to review the spectrum of this disorder in the last two decades.
Methods:
During the period 1979-96 a total of 102 consecutive infants and children were diagnosed in Royal Alexandra Hospital for Children with gallstones or common bile duct calculi. A detailed retrospective analysis and follow-up of these children form the basis of the present report.
Results:
The median age at presentation was 10 years. Recurrent right upper quadrant pain was the most common clinical presentation. The male-to-female ratio was 3:2 and this male predominance was noted in all the age groups. Aetiologically three identifiable groupings were noted: idiopathic disease (n = 66), haematological diseases (n = 23) and specific non-haematological disease (n = 13). The incidence of idiopathic and haematological stones had increased two-fold in the second half of the study. The majority of children (86%) underwent surgical correction. Choledocholithiasis (CDL) was noted in 18 children (18%). Jaundice was commonly associated with abdominal pain in this group. A higher incidence of common bile duct calculi was noted in females and children less than 5 years of age (P < 0.01). Common bile duct calculi were accurately diagnosed by pre-operative imaging in all 18 children. Surgical correction was required in all except two.
Conclusions:
The present study suggests an increasing incidence of gallstones in children. Cholelithiasis in children occurs commonly in boys, is idiopathic in aetiology and presents with a vague right upper quadrant pain. Choledocholithiasis is not uncommon in children, occurs more commonly in girls aged < 5 years and presents with jaundice or abnormal liver function tests.