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Gallstones in children. Characterization by age, etiology, and outcome
S Reif1, D G Sloven, E Lebenthal
1Division of Gastroenterology and Nutrition, Children's Hospital of Buffalo, NY.
Insights
Pediatric gallstones are linked to hemolytic disease, parenteral nutrition, and idiopathic causes. Unlike adults, there
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Surgical Outcomes
Background:
- Gallstones (cholelithiasis) are less common in children than adults.
- Understanding pediatric gallstone etiology and presentation is crucial for diagnosis and management.
Purpose of the Study:
- To analyze the characteristics, etiologies, and outcomes of gallstones in a pediatric population.
- To compare pediatric gallstone presentation with adult populations.
Main Methods:
- Retrospective chart review of 50 children and adolescents diagnosed with gallstones over 10 years.
- Data collection included patient demographics, clinical presentation, etiology, diagnostic methods, and treatment outcomes.
- Ultrasonography was the primary diagnostic tool; cholecystectomy was the main surgical intervention.
Main Results:
- Fifty pediatric patients (mean age 12.2 years; 21 boys, 29 girls) were identified.
- Major etiological groups included hemolytic disease (18), parenteral nutrition (8), adolescent pregnancy (7), and idiopathic (10).
- Right upper quadrant pain and jaundice were common symptoms; pancreatitis was the most frequent complication (8%).
Conclusions:
- Pediatric gallstone causes differ from adults, with hemolytic disease and parenteral nutrition being significant factors.
- Excluding adolescent pregnancy cases, no female predominance was observed, contrasting with adult gallstone epidemiology.
- Clinical presentation varies with age and underlying risk factors, necessitating tailored diagnostic and management approaches.
Abstract:
Fifty children and adolescents were found to have gallstones at Children's Hospital of Buffalo (NY) during a period of 10 years. The mean (+/- SD) age was 12.2 +/- 6.2 years, with 21 boys and 29 girls. The majority of patients could be categorized into four groups: hemolytic disease (18 patients), parenteral nutrition (eight patients), adolescent pregnancy (seven patients), and idiopathic (10 patients), while seven patients had a variety of other etiologies. Right upper quadrant pain was the most common symptom (32 patients), followed by jaundice (15 patients), vomiting (13 patients), and nonspecific abdominal complaints (13 patients). Ten patients presented with jaundice and underlying hemolytic disease; seven patients were asymptomatic. Clinical presentation was found to vary with age and factors associated with the development of gallstones. Ultrasonography was the mode of diagnosis in 48 patients. Cholecystectomy was performed in 36 patients. In contrast to gallstones in adults, after exclusion of the patients with adolescent pregnancy, there was no female predominance. Pancreatitis was the most common complication, occurring in 8% of the patients; cholecystitis and cholangitis were absent.