Gallstone disease in children

Area of Science:

• Pediatric Gastroenterology
• Hepatobiliary Diseases
• Pediatric Surgery

Background:

• Cholelithiasis (gallstones) and choledocholithiasis (bile duct stones) are increasingly diagnosed in children, largely due to widespread ultrasonography use.
• Limited epidemiological data exists for pediatric gallstones in India, with no consensus on management among specialists.
• This review aims to raise awareness regarding the diagnosis and management of gallstones in pediatric populations.

Purpose of the Study:

• To review the current understanding of pediatric cholelithiasis epidemiology and management.
• To increase awareness among healthcare professionals regarding gallstone management in children.
• To provide insights into the various etiologies and clinical presentations of gallstones in pediatric patients.

Main Methods:

• An extensive electronic literature search was conducted using PubMed.
• Reviewed original articles, clinical trials, case series, and review articles related to gallstones in children.
• Synthesized findings to provide a comprehensive overview of the topic.

Main Results:

• Etiologies of cholelithiasis include hemolytic conditions (20-30%), other known factors like total parenteral nutrition (TPN) and ileal disease (40-50%), and idiopathic causes (30-40%).
• Spontaneous resolution of gallstones is common in infants, warranting observation even for bile duct stones.
• Children present with typical biliary symptoms (50%), nonspecific symptoms (25%), are asymptomatic (20%), or have complications (5-10%).

Conclusions:

• Cholecystectomy (gallbladder removal) is beneficial for children with typical biliary symptoms but not recommended for those with nonspecific symptoms.
• Prophylactic cholecystectomy is advised for children with hemolytic disorders.
• A period of observation is recommended for infants with gallstones, including those with bile duct stones, due to frequent spontaneous resolution.