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[Cholelithiasis in children with sickle cell disease: experience of a French pediatric hospital]
1Service de pédiatrie générale, pathologies infectieuses et tropicales, hôpital d'enfants Armand-Trousseau, 75571 Paris, France. nathalie.parez@trs.ap-hop-paris.fr
Insights
Gallstones (cholelithiasis) are common in children with sickle cell disease and can cause serious complications. Early detection via annual ultrasounds from age seven and prompt surgical intervention are recommended.
Area of Science:
- Pediatric Gastroenterology
- Hematology
- Surgical Oncology
Background:
- Gallstones (cholelithiasis) are a frequent complication in pediatric sickle cell disease patients.
- Complications of gallstones can mimic vaso-occlusive pain crises, complicating diagnosis and management.
- These complications can pose life-threatening risks to affected children.
Purpose of the Study:
- To describe the local experience with gallstones in children diagnosed with sickle cell disease.
- To evaluate the clinical presentation, diagnosis, and management of cholelithiasis in this population.
Main Methods:
- Retrospective analysis of follow-up records and abdominal sonography results.
- Study included 185 children with sickle cell anemia (ages 0-18) from 1982-1998.
- Data collected on cholelithiasis diagnosis, clinical manifestations, and surgical interventions.
Main Results:
- Gallstones were detected in 26 pediatric patients, with the youngest diagnosed at age five.
- Clinical manifestations led to diagnosis in 12 patients; 28% of asymptomatic cases developed symptoms within 2.5 years.
- Laparoscopic cholecystectomy resulted in a shorter postoperative hospital stay compared to open procedures; 85% of gallbladders showed acute or chronic cholecystitis.
Conclusions:
- Gallstones should be actively investigated in sickle cell patients presenting with abdominal symptoms.
- Annual abdominal sonography is recommended for early detection starting at age seven.
- Elective cholecystectomy is advised for patients diagnosed with cholelithiasis to prevent complications.
Background:
Gallstones are frequently encountered in sickle cell disease. Their complications are difficult to distinguish from vaso-occlusive abdominal pain and they can sometimes threaten the patient's life. The aim of this study was to describe our local experience with cholelithiasis in children with sickle cell disease.
Patients And Methods:
We analyzed the follow-up records and abdominal sonography results of 185 children with sickle cell anemia, aged zero to 18 years, followed up in Trousseau Children's Hospital (Paris) from 1982 to 1998.
Results:
Cholelithiasis was detected in 26 patients. The youngest patient was five years old. Cholelithiasis was discovered because of clinical manifestations in 12 patients. Asymptomatic cholelithiasis patients developed clinical manifestations in 28% cases in a maximum delay of two and a half years after its diagnosis. Laparoscopic cholecystectomy was performed in nine cases and open cholecystectomy in 17 cases. The mean postoperative length of stay was significantly shorter in the group of patients with laparoscopy in comparison with the group with open cholecystectomy. Histologic analysis of the gallbladders noted 85% of acute or chronic cholecystis.
Conclusion:
We suggest that cholelithiasis should be carefully sought in the presence of abdominal manifestations in sickle cell patients. We recommend that annual abdominal sonography be performed in sickle cell patients as early as seven years of age and elective cholecystectomy be performed on patients with cholelithiasis.
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