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Risk factors, complications, and outcomes of gallstones in children: a single-center review
Conor O Bogue1, Amanda J Murphy, J Ted Gerstle
1Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada. cbogue@eircom.net
Insights
Silent gallstones in children are common and usually have low complication rates. Conservative management is often suitable unless complications arise, especially in infants.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Surgical Outcomes
Background:
- Increasing use of sonography leads to more asymptomatic pediatric gallstone diagnoses.
- Limited evidence exists for expectant management of silent gallstones in children compared to adults.
- This study reviews risk factors, complications, and outcomes of pediatric gallstones, focusing on asymptomatic cases.
Purpose of the Study:
- To evaluate risk factors, complications, and outcomes of pediatric gallstones.
- To specifically analyze outcomes for children diagnosed with asymptomatic gallstones.
- To inform management strategies for pediatric gallstone disease.
Main Methods:
- Retrospective review of 382 pediatric gallstone cases diagnosed via sonography.
- Data collection included age, presentation, risk factors, complications, surgery, and follow-up.
- Chi-squared test compared complication rates between symptomatic and asymptomatic groups.
Main Results:
- 50.5% of pediatric gallstone patients were asymptomatic at diagnosis, with a mean age of 8.23 years.
- Asymptomatic patients had significantly lower complication rates (4.6%) than symptomatic ones (28.2%).
- Only 3.1% of asymptomatic patients required surgery, with higher rates of resolution observed in infants and asymptomatic children.
Conclusions:
- Clinically silent gallstones in children and infants are associated with low complication rates.
- Conservative management is suggested for asymptomatic pediatric gallstones unless complications develop.
- Patients with specific hemolytic conditions (sickle cell disease, spherocytosis, elliptocytosis) showed higher complication and surgery rates.
Background And Objective:
The increasing use of sonography has resulted in an increase in the proportion of children with gallstones who are asymptomatic at the time of diagnosis. In adults, the literature supports expectant management of clinically silent gallstones. The evidence for this management approach in children is limited to a number of small series. Our objective was to review the risk factors, complications, and outcomes of gallstones at our institution, particularly in those patients who are asymptomatic at the time of initial diagnosis.
Materials And Methods:
We reviewed 382 cases of gallstones in children. These patients were diagnosed with sonography. Data on age at diagnosis, presentation, sonographic findings, risk factors, complications, surgery, and follow-up were collected. A chi2 test was used to compare the complication rates between symptomatic and asymptomatic groups. Descriptive statistics were used to analyze the sample.
Results:
At diagnosis, 50.5% of children were asymptomatic; these patients were diagnosed at a mean age of 8.23 years. Compared with symptomatic patients, they were less likely to have a hemolytic anemia but more likely to have other risk factors, including cardiac surgery, leukemia and lymphoma, short bowel syndrome, or exposure to total parenteral nutrition or cephalosporins. These patients had a lower rate of complications than the symptomatic patients (4.6% vs 28.2% of symptomatic, P < 0.0001) and only 3.1% developed symptoms that necessitated surgery (vs 59.0% of symptomatic). Of the 58 (15.1%) diagnosed in infancy, 47 (81.0%) were asymptomatic. The infant group also had low rates of complications (8.6%) and cholecystectomy (1.7%). In cases with sonographic follow-up, resolution of gallstones was demonstrated in 16.5% of asymptomatic patients and in 34.1% of infants.
Conclusions:
The data suggest that clinically silent gallstones in children and infants are associated with low rates of complications and can be managed conservatively, unless complications occur. Patients with sickle cell disease, spherocytosis, and elliptocytosis had high complication rates and required surgery more often.
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