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The management of nonpigmented gallstones in children
1University of Toronto, The Hospital for Sick Children, Ontario, Canada.
Insights
Pediatric gallstones can often be managed non-surgically. Children with typical symptoms need surgery, but those with atypical or no symptoms may improve with diet or observation.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Surgical Management
Background:
- Gallstone prevalence in children is rising.
- Optimal management for pediatric gallstones, excluding those with hematologic issues, remains unclear.
Purpose of the Study:
- To investigate the clinical presentation, natural history, and outcomes of pediatric gallstones.
- To determine appropriate management strategies for pediatric cholelithiasis.
Main Methods:
- Prospective study of 74 children diagnosed with gallstones via ultrasound.
- Evaluation of clinical presentation, complications, and surgical indications.
- Follow-up averaged 21 months, including clinic visits and questionnaires.
Main Results:
- 33 children underwent cholecystectomy; 41 were managed conservatively.
- Children with risk factors for gallstones required earlier surgery.
- Of those followed, 82% with atypical symptoms improved with dietary changes; no complications occurred.
Conclusions:
- Cholecystectomy is recommended for children with typical gallstone symptoms (e.g., RUQ pain, food intolerance).
- Asymptomatic pediatric patients or those with atypical symptoms can be safely monitored, with many benefiting from dietary adjustments.
Background/Purpose:
An increasing number of children are diagnosed with gallstones today. The best management of nonpigmented gallstones in children without hematologic disorders is not known.
Methods:
The authors prospectively studied 74 children with cholelithiasis diagnosed with ultrasonography. Clinical presentation, natural history, complications, and indications for cholecystectomy were examined. The follow-up (mean, 21 months) consisted of routine clinic visits, chart reviews, and telephone questionnaires with the children or their parents.
Results:
Of the 74 children, 33 required cholecystectomies, and 41 were followed. The average age was similar in the 2 groups (11.7 v 11.0 years). Children with risk factors for cholelithiasis required earlier surgical treatment (P < .001). In the operative group, 8 presented acutely and 25 electively. There were 2 complications, a wound infection and a retained common duct stone. In the group that underwent follow-up, 34 of 41 children remained asymptomatic or had symptoms improve with dietary manipulation. No complications developed during the follow-up period.
Conclusions:
Children with gallstones and typical symptoms of right upper quadrant or epigastric pain with food intolerance should undergo cholecystectomy. Eighty-two percent of children with cholelithiasis and atypical symptoms had improvement with dietary manipulation. Pediatric patients with gallstones that are asymptomatic or associated with atypical symptoms can be safely followed without complications.