Related Experiment Videos
Management of cholelithiasis in pediatric patients who undergo bone marrow transplantation
S D Safford1, K M Safford, P Martin
1Departments of Surgery and Pediatrics, Duke University Medical Center, Durham, NC, USA.
Insights
Gallstones (cholelithiasis) are common in children undergoing bone marrow transplantation (BMT), especially those treated for bone marrow failure. Asymptomatic gallstones in these patients can often be managed non-surgically.
Area of Science:
- Pediatric Hematology/Oncology
- Gastroenterology
- Transplantation Medicine
Background:
- Gallstones (cholelithiasis) can be a complication in pediatric patients undergoing bone marrow transplantation (BMT).
- Understanding the incidence and risk factors for cholelithiasis in this population is crucial for appropriate management.
- Asymptomatic gallstones may not require immediate intervention, but their natural history in BMT patients needs characterization.
Purpose of the Study:
- To determine the incidence of asymptomatic cholelithiasis in children undergoing BMT.
- To identify risk factors associated with gallstone formation in this patient group.
- To evaluate the proper management strategies for asymptomatic cholelithiasis in pediatric BMT recipients.
Main Methods:
- Retrospective review of 575 pediatric patients undergoing BMT.
- Abdominal ultrasonography was performed on 235 patients for specific clinical indications.
- Patients were stratified by disease and treatment regimen to identify risk factors for cholelithiasis.
Main Results:
- Cholelithiasis was identified in 8.5% (20/235) of pediatric BMT patients who underwent ultrasonography.
- Patients treated for bone marrow failure had a significantly higher risk (27%) compared to those treated for malignancy (7.4%).
- Most cases (85%) did not require surgery; 15% developed acute cholecystitis and underwent surgery without complications.
Conclusions:
- Cholelithiasis is a frequent finding in pediatric BMT patients.
- Children undergoing BMT for bone marrow failure are at increased risk for gallstones.
- Nonoperative management is a suitable strategy for asymptomatic cholelithiasis in this selected pediatric population.
Purpose:
The aim of this study was to determine the incidence, risk factors, and proper management for asymptomatic cholelithiasis in children undergoing bone marrow transplantation (BMT).
Methods:
The authors reviewed retrospectively the records of 575 children who underwent bone marrow transplantation at a University bone marrow transplantation unit (BMT) unit between February 1991 and October 1999. Of these patients, 235 underwent abdominal ultrasonography for evaluation of jaundice, sepsis, abdominal pain, or metastasis. To identify risk factors for cholelithiasis, the authors stratified the patients based on their disease and treatment regimen. Finally, the authors analyzed the natural history and management of BMT children with cholelithiasis.
Results:
The authors identified 20 cases of cholelithiasis (8.5%) in the 235 BMT patients who underwent ultrasonography. Children who underwent BMT to treat bone marrow failure showed a significantly increased risk of cholelithiasis compared with children treated for malignancy (27% v 7.4%; P<.01). Most children (85%) with gallstones did not require surgical intervention. Specifically, 9 (45%) died from their primary disease, 5 (25%) showed sonographic resolution of their gallstones, and 3 (15%) underwent follow-up nonoperatively with persistent cholelithiasis. Three of the 20 patients with gallstones (15%) had signs of acute cholecystitis and underwent surgery. There were no surgical complications or deaths in the operative group.
Conclusions:
Cholelithiasis occurs at a high incidence in pediatric bone marrow transplant patients. Children undergoing BMT for bone marrow failure are at higher risk of having gallstones than those being treated for malignancy. Finally, these data support a strategy of nonoperative management for asymptomatic cholelithiasis in this highly selected group of patients.