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Changing spectrum of cholelithiasis and cholecystitis in infants and children
P V Bailey1, R H Connors, T F Tracy
1Department of Pediatric Surgery, Cardinal Glennon Children's Hospital, St. Louis University Medical Center, Missouri.
Insights
Childhood cholelithiasis (gallstones) and cholecystitis (gallbladder inflammation) are increasing, particularly in infants. Early surgical intervention for pediatric gallstone disease is crucial to prevent serious complications.
Area of Science:
- Pediatric Gastroenterology
- Hepatobiliary Surgery
- Epidemiology of Pediatric Diseases
Background:
- Cholelithiasis and cholecystitis are uncommon in children, historically linked to pregnancy or hemolytic conditions.
- The incidence and presentation of pediatric gallstone disease appear to be evolving.
- A study was conducted to analyze trends in pediatric cholelithiasis over two decades.
Purpose of the Study:
- To evaluate changes in the incidence and characteristics of cholelithiasis and cholecystitis in children.
- To compare patient demographics and risk factors between two distinct time periods.
- To assess the evolving spectrum and complications of pediatric gallstone disease.
Main Methods:
- Retrospective chart review of 47 pediatric patients (<17 years) who underwent cholecystectomy between 1970-1988.
- Patients were divided into two chronological groups: 1970-1979 (Group 1) and 1980-1988 (Group 2).
- Comparison of age, sex, pregnancy, blood dyscrasia, family history, obesity, total parenteral nutrition (TPN) use, and choledocholithiasis incidence.
Main Results:
- A significant increase in pediatric cholelithiasis was observed over the study period.
- Group 2 showed a higher incidence in infants and young children, with many having a history of TPN.
- Choledocholithiasis (gallstones in the bile duct) was more frequent in Group 2, leading to severe complications.
Conclusions:
- Pediatric gallstone disease is becoming more prevalent and affects younger children.
- Total parenteral nutrition (TPN) is a notable risk factor in contemporary pediatric cases.
- Prompt surgical management is essential to mitigate the rising incidence of complications from childhood cholelithiasis.
Abstract:
Cholecystitis and cholelithiasis are infrequent in children and have been historically associated with adolescent pregnancy or hemolytic disorders; however, the incidence and spectrum of cholelithiasis seem to be changing. Between 1970 and 1988, 47 children 17 years of age or less underwent cholecystectomy for cholecystitis or cholelithiasis in our hospital. The patients were divided into chronologic groups: Group 1 encompassed 1970 through 1979 (15 patients) and group 2, 1980 through 1988 (32 patients). The groups were compared for age, sex, pregnancy, blood dyscrasia, family history, obesity, use of total parenteral nutrition (TPN), and incidence of choledocholithiasis with its sequelae. A significant increase in the number of patients with cholelithiasis was found. Infants and young children were affected more frequently in group 2, and many of these young patients had a history of TPN. Choledocholithiasis was also more common in group 2 and presented with life-threatening sequelae. Calculous biliary tract disease should be considered as a possible cause of abdominal pain in children. Timely operative intervention can prevent the increasingly common sequelae of childhood cholelithiasis.