Cholelithiasis and cholecystitis: changing prevalence in an African community

Cholelithiasis and cholecystitis were thought to be rare in Africans. It is now seen more frequently than previously thought. The essence of this study is to determine the prevalence of cholelithiasis and cholecystitis in a Nigerian population, changing pattern and outcome.

Descriptive study over a five-year period in an urban teaching hospital in Nigeria.

All cases of inflammatory gallbladder disease seen in the University of Ilorin Teaching Hospital, Ilorin, Nigeria, from January 1997 to December 2001 were studied prospectively. Only those who had a surgical operation and histological confirmation of cholelithiasis and cholecystitis were included in the study. The patients' demographic details, clinical presentation, findings at surgical operation and histological results of gallbladder specimens and outcome were studied.

In this study, 46 patients had cholecystectomy for cholelithiasis and cholecystitis in five years. In the first three years, 18 (39.1%) cases were seen, but in the next two years 28 (60.9%) patients had cholecystectomy. The male:female ration was 1:4.8. Only four (8.7%) of these patients were obese. Thirty-two (69.6%) were multiparous. Only four (8.7%) of the patients had pigmented stones, the majority of which were mixed stones. Many of the patients have been on treatment for suspected peptic ulcer disease for a period ranging from four weeks to five years. One of the patients had Mirizzi syndrome type 1. Abdominal ultrasound was found useful in the diagnosis. All patients had open cholecystectomy. Outcome of treatment was satisfactory.

We are beginning to have an increase in gallbladder disease probably as a result of changing dietary habits (increase in intake of calories and cholesterol/fats) of the population. A high index of suspicion and careful clinical judgment coupled with the use of simple ancillary investigation like ultrasound will make early diagnosis and treatment feasible.