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A retrospective review of children with gallstone: single-center experience from Central Anatolia
Selim Gökçe1, Miraç Yıldırım, Derya Erdoğan
1Department of Pediatric Gastroenterology, Hepatology and Nutrition, Bezmiâlem Vakif University Faculty of Medicine, İstanbul, Turkey.
Insights
Pediatric gallstones are more likely to resolve in infants, with ceftriaxone-associated stones showing high resolution rates. Asymptomatic gallstones in children have a low complication rate, suggesting clinical follow-up is preferred over surgery.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Pediatric Surgery
Background:
- Gallstones in children are increasingly recognized.
- Understanding their characteristics is crucial for appropriate management.
Purpose of the Study:
- To analyze demographic features, presentation types, risk factors, laboratory findings, complications, and outcomes of pediatric gallstones.
- To compare symptomatic versus asymptomatic gallstone presentations in children.
Main Methods:
- A retrospective study of 124 children with sonographically diagnosed gallstones.
- Stratification into symptomatic (Group 1) and asymptomatic (Group 2) groups.
- Data collection from medical charts and statistical analysis.
Main Results:
- Females were older than males at diagnosis. Asymptomatic presentation correlated with hemolytic anemia and oncologic status.
- Complications occurred in 12.9% of children, more frequently in the symptomatic group (18.4%).
- Gallstone resolution was observed in 29.4% of symptomatic and 23.3% of asymptomatic children. Infants (<2 years) had significantly higher resolution rates (50.0%) compared to older children (19.8%).
Conclusions:
- Ceftriaxone-associated gallstones often resolve spontaneously. Ursodeoxycholic acid (UDCA) treatment showed limited efficacy.
- Young age is a significant predictor of gallstone resolution.
- Asymptomatic pediatric gallstones have a low complication rate, supporting clinical follow-up over surgical intervention, especially in infants.
Background/Aims:
To evaluate children with gallstone in respect to demographic features, type of presentation, predisposing risk factors, laboratory features, complications, and outcome.
Materials And Methods:
Overall, 124 children with sonographically diagnosed gallstone were stratified into group 1 (symptomatic) and group 2 (asymptomatic). The data on demographic features, predisposing risk factors, laboratory features, complications, and outcome were collected from medical charts and compared by using convenient statistical methods.
Results:
There were 76 (61%) children in group 1. Females were significantly older than males at the time of diagnosis (p=0.001). After adjusting for age and sex, asymptomatic presentation was associated with hemolytic anemia (r=346, <0.001) and being an oncologic patient (r=248, p=0.006). No risk factor was specifically associated with having a symptomatic presentation. Sixteen children (12.9%) developed complications: 14 (18.4%) in group 1 and 2 (4.2%) in group 2 (p=0.027). Gallstone resolution was detected in 20 (29.4%) and 10 children (23.3%) in groups 1 and 2, respectively (p=0.477). Resolution was observed in 43.8% of children with ceftriaxone-associated gallstone. The rate of resolution with ursodeoxycholic acid (UDCA) was similar to that observed with expectant management. Gallstone resolution was evident in 9 infants (50.0%) and was significantly higher than children over 2 years of age (21 out of 106 children, 19.8%) (p=0.006). The most important factor associated with gallstone resolution was to be an infant (<2 years of age) at the time of diagnosis (OR: 3.1; 95% CI: 1.1-8.8; p=0.034).
Conclusion:
Ceftriaxone-associated gallstones are most likely to resolve but do not always undergo spontaneous resolution. UDCA treatment seems to be ineffective. Young age is a favorable factor for gallstone resolution. The rate of complications in children with asymptomatic presentation is considerably low. Thus, clinical follow-up rather than surgical intervention is suggested in children with asymptomatic presentation and in infants.
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