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Etiology-Based Decision-Making Protocol for Pediatric Cholelithiasis
Vikesh Agrawal1, Abhishek Tiwari2, Dhananjaya Sharma3
1Pediatric Surgery Division, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh. Correspondence to: Dr Vikesh Agrawal, Department of Surgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh. drvikeshagrawal@gmail.com.
Objectives:
We reviewed hospital records of pediatric cholelithiasis to develop an etiology-based decision-making protocol.
Methods:
This retrospective study was conducted on consecutive pediatric cholelithiasis patients from July, 2014 to June, 2019 in a tertiary care center. Pediatric cholelithiasis was classified according to etiology, and the outcome of medical/surgical treatment was noted.
Results:
Data of 354 pediatric patients were analyzed. Commonest (56.2%) etiology was idiopathic; followed by ceftriaxone pseudo-lithiasis (26.8%). Pigment stones were associated with the highest rate of complications. Non-hemolytic stones had a lower complication rate and a high rate of resolution with medical therapy.
Conclusions:
Hemolytic and symptomatic stones warrant an early cholecystectomy, whereas asymptomatic idiopathic stones, ceftriaxone stones, and TPN-induced stones are candidates for medical therapy under close observation.
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