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Published on: February 28, 2025
[Management of pediatric cholelitiasis: our experience]
M Cofini1, P Favoriti, S Pietrantoni
1Clinica Pediatrica, Università di Perugia, Perugia, Italia - tantalina85@hotmail.it.
Insights
Pediatric cholelithiasis (gallstones) management in children shows laparoscopic cholecystectomy as a safe and effective treatment. Conservative management and ursodeoxycholic acid (UDCA) offer symptomatic relief but do not dissolve gallstones.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Imaging
Context:
- Cholelithiasis, or gallstones, is increasingly diagnosed in pediatric populations.
- Understanding the clinical presentation, etiology, and treatment outcomes is crucial for effective management.
- This study evaluates a cohort of pediatric patients diagnosed with gallstones between 2008 and 2011.
Purpose:
- To describe the clinical characteristics, diagnostic methods, and treatment approaches for pediatric cholelithiasis.
- To evaluate the efficacy and safety of both surgical and medical management strategies.
- To report on the follow-up outcomes of children treated for gallstones.
Summary:
- A retrospective review of 24 children (7-17 years) with cholelithiasis diagnosed via ultrasonography.
- 16 patients underwent laparoscopic cholecystectomy, while 10 received conservative management; ursodeoxycholic acid (UDCA) was used in 2 cases.
- No major morbidity or mortality was observed. Laparoscopic cholecystectomy is confirmed as a safe and effective treatment, with UDCA providing symptomatic improvement.
Impact:
- Laparoscopic cholecystectomy is established as the gold standard for pediatric gallstone treatment.
- Conservative management and UDCA can be effective for symptom control in select pediatric cases.
- This study contributes to evidence-based guidelines for managing gallstones in children.
Aim:
The aim of this retrospective study was to report our experience about characteristics of clinical presentation, etiologies, diagnosis and medical or surgical treatment of pediatric cholelitiasis.
Methods:
Twenty-four children, ranging from 7 to 17 years of age (14 females and 10 males), with diagnosis of cholelitiasis were studied from 2008 through 2011. Exclusion criteria included: active infection, cholangitis, severe anemia or thrombocytopenia in cases with hemolytic diseases. Diagnosis was performed with abdominal ultrasonography-scanner (US). Furthermore, complete peripheral blood examination was performed to all patients. Follow-up was conducted by clinical and US and/or CT supports between 6 and 24 months.
Results:
Laparoscopic cholecystectomy was performed in 16 patients, conservative management in 10. No cases of majority morbility or death rate were found. RMN-colangiography was conducted in 2 cases with cholestasis elevated index: no stone were found in common bile duct. During follow-up evaluation, 2 patients began sympotimatic and were undergone to cholecystectomy. "Wait and see" management was performed in all asymptomatic cases. In only 2 cases ursodeoxycholic acid (UDCA) was administrated.
Conclusion:
Laparoscopic cholecystectomy is a "gold standard" also for a treatment of cholelitiasis in childhood; it is an efficacy and safe treatment also for pediatric gallstones. Medical therapy with UDCA lead not to dissolution of gallstones but it had a positive effect on the symptoms.
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