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[Cholelithiasis in childhood. Proposals based on a multicentric study]
J Elías Pollina1, J Garate, E Martin Bejarano
1Servicio de Cirugía Pediátrica, Hospital Miguel Servet, Zaragoza.
Insights
Gallstones in children are often found incidentally and diagnosed via ultrasonography. Management strategies for pediatric cholelithiasis range from expectant observation to surgical intervention based on symptoms and gallbladder function.
Area of Science:
- Pediatric Gastroenterology
- Hepatobiliary Surgery
Context:
- Cholelithiasis (gallstones) in pediatric patients presents unique diagnostic and management challenges.
- This study reviews 56 cases of pediatric gallstones across 11 hospitals, analyzing clinical presentation, diagnostic methods, and treatment outcomes.
- Infant symptomatology is often non-specific, complicating early diagnosis.
Purpose:
- To review and analyze cases of cholelithiasis in patients aged two months to 15 years.
- To evaluate diagnostic modalities, particularly ultrasonography, for pediatric gallstones.
- To assess the effectiveness of different management strategies, including surgical and conservative approaches.
Summary:
- Ultrasonography is the primary diagnostic tool, with a high success rate in identifying gallstones.
- Incidental findings account for a significant portion of pediatric cholelithiasis cases (41%).
- Management varies: surgical intervention for symptomatic or non-functioning gallbladders, conservative management for asymptomatic cases, and careful evaluation for those with predisposing factors or recurrent pain.
- The study noted a potential link to 'lithogenic families' and the occurrence of gallstones in four patients with Down syndrome.
Impact:
- Provides evidence-based recommendations for managing pediatric cholelithiasis, guiding clinical decision-making.
- Highlights the importance of ultrasonography in pediatric gallstone diagnosis.
- Suggests a need for further research into genetic predispositions and associations with conditions like Down syndrome in pediatric gallstone disease.
Abstract:
Fifty six cases of cholelithiasis in patients aged two months to 15 years (mean age 7.65 years) concerning to 11 hospitals are reviewed. The study protocol followed was the same in all medical records, although own criterions were considered on management performed in each center. From the cases, it follows: 1. Male/female rate is 1/1.5. 2. Symptomatology in infancy is relatively poor and pain localization is not orientative. 3. It was an incidentally finding in 41 per 100 of the cases. 4. Ultrasonography is the best examination procedure rendering diagnosis in the 51 cases it was underwent. 5. Hematologic study was abnormal in six of 46 cases. 6. Medical treatment was not performed in any hospital. 7. Existence of "lithogenic families" seems to be demonstrated. 8. The presence of four patients with Down syndrome in this series must be pointed out. 9. Among total 56 cases, 21 underwent surgical treatment, 29 were conservatively treated, two have died and four patients had spontaneous stone resolution. 10. In the face of these, we propose: A) Surgical treatment in symptomatic cases, porcelain gallbladder and nonfunctionating gallbladder. B) Expectant management and sonographic monitoring in asymptomatic cases. C) Carefully evaluation in patients with predisposing factors and patients with recurrent abdominal pain.