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Published on: February 28, 2025
[Cholelithiasis in children: a clinical and morphological study]
Paul Harris1, Bernardita Chateau, Juan Francisco Miquel
1Pontificia Universidad Católica de Chile, Facultad de Medicina, Departamento de Pediatría, Lira 44, Santiago, Chile. pharris@med.puc.cl
Insights
Pediatric biliary stones are increasingly diagnosed with ultrasound. Surgery decisions for children with gallstones rely on symptoms, not lab tests or family history, with cholesterol stones being common.
Area of Science:
- Pediatric Gastroenterology
- Hepatobiliary Surgery
- Diagnostic Imaging
Background:
- Ultrasonography has increased the diagnosis of cholelithiasis (gallstones) in children.
- Biliary stones in pediatric populations present unique diagnostic and management challenges.
Purpose of the Study:
- To investigate the clinical and laboratory features of children diagnosed with biliary stones.
- To analyze the follow-up and surgical management of pediatric patients with gallstones.
Main Methods:
- Prospective enrollment of 26 children (aged 1 month to 14 years) with biliary stones.
- Diagnosis confirmed via abdominal ultrasound in all cases.
- Surgical intervention (cholecystectomy) considered based on clinical presentation.
Main Results:
- Vomiting, abdominal pain, and jaundice were common presenting symptoms.
- Surgery was performed in 15 children, with laparoscopy being the preferred method.
- Both pigmented and cholesterol gallstones were identified, with a notable proportion of cholesterol stones.
Conclusions:
- Clinical symptoms, rather than family history or laboratory tests, guided surgical decisions in pediatric gallstone cases.
- The high prevalence of cholesterol gallstones in this pediatric cohort may be geographically specific.
- Further research into the etiology and management of pediatric cholelithiasis is warranted.
Background:
The use of ultrasonography increased the frequency of diagnosis of cholelithiasis in childhood.
Aim:
To determine the clinical and laboratory features and follow up of children with biliary stones.
Patients And Methods:
Twenty six children (13 male, aged 1 month to 14 years) were prospectively enrolled.
Results:
Nine children had a past medical history of factors potentially predisposing to stones. A clinical presentation with vomiting (50%), abdominal pain (46%) and jaundice (23%) was the most common indication for surgery. The diagnosis was based on abdominal ultrasound in all children. Cholecystectomy was performed in 15 children (laparoscopy in 13 and open surgery in 2). Children who underwent surgery were older than those who did not undergo surgery (p < 0.001), but they did not have differences in liver function tests. Eight children had pigmented stones and seven had cholesterol stones.
Conclusions:
In our patients, neither family history nor laboratory tests were useful in the diagnosis as well as in the clinical decision of surgery, which was based on symptoms. The presence of cholesterol stones in a high proportion of these children may be a unique situation in Chile, considering the high prevalence of this disease in the adult population.
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