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[Childhood cholelithiasis in a district hospital]
M R Cozcolluela Cabrejas1, L A Sanz Salanova, M T Martínez-Berganza Asensio
1Servicios de Radiología, Hospital Reina Sofía, Tudela, España. rcozcolc@cfnavarra.es
Insights
Pediatric cholelithiasis (gallstones) is uncommon but increasingly detected. Ultrasound is the primary diagnostic tool, with plain abdominal X-rays also proving useful for identifying gallstones in children.
Area of Science:
- Pediatric Gastroenterology
- Hepatobiliary Disease
Context:
- Cholelithiasis (gallstones) is rare in children, though detection rates are rising.
- A retrospective study analyzed pediatric cholelithiasis cases from 1993-2005 at Reina Sofia Hospital, Tudela, Spain.
Purpose:
- To investigate the incidence, predisposing factors, clinical presentation, diagnostic methods, and management of cholelithiasis in pediatric patients.
- To evaluate the utility of ultrasonography and plain abdominal X-ray in diagnosing pediatric gallstones.
Summary:
- The study identified 18 pediatric cases of cholelithiasis and 3 with biliary sludge.
- Predisposing factors included prematurity, parenteral nutrition, sepsis, obesity, and family history; 11 cases were idiopathic.
- Common symptoms were abdominal pain and vomiting; two patients presented with appendicular symptoms. Ultrasonography was the main diagnostic tool, with plain abdominal X-ray detecting 80% of lithiasis cases.
- Fourteen patients underwent cholecystectomy (12 laparoscopic, 2 open); none required emergency surgery.
Impact:
- Highlights that pediatric cholelithiasis, while unusual, is not exceptional and presents with nonspecific symptoms.
- Emphasizes the diagnostic value of ultrasonography and plain abdominal X-ray in pediatric gallstone disease.
- Provides insights into risk factors and management strategies for gallstones in children, informing clinical practice and future research.
Abstract:
Cholelithiasis is a rare finding in children, even though recent series show increased detection of this disease. A retrospective study was performed in children with a diagnosis of cholelithiasis between 1993 and 2005 in the Reina Sofia Hospital in Tudela (Spain). Eighteen patients with cholelithiasis and three with biliary sludge were detected. Predisposing factors for cholelithiasis were prematurity and parenteral nutrition (one patient), sepsis (two patients), obesity (one patient), and a family history of the disease (one patient). The disease was idiopathic in 11 patients. Gallstones were detected in two patients presenting with appendicular symptoms. One child with biliary sludge had received treatment with ceftriaxone as a predisposing factor. All patients were diagnosed by ultrasound. Plain abdominal X-ray detected lithiasis in 12 of the 15 patients (80 %) with cholelithiasis who underwent this procedure. The most frequent symptoms were abdominal pain (seven patients), abdominal pain and vomiting (five patients), and diarrhea (one patient). Two patients presented with appendicular symptoms. Fourteen patients underwent surgery (open cholecystectomy in two and laparoscopic cholecystectomy in 12). None of the patients required emergency surgery. Cholelithiasis in children is an unusual finding, but is not exceptional and is associated with nonspecific symptoms. Plain abdominal X-ray is useful in diagnosis but the main diagnostic technique is ultrasonography.
