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Published on: September 13, 2022
Clinical characteristics and prognosis of primary hepatolithiasis in hospitalized children
Jiayu Yan1, Zhiyi Zhang1, Jianlin Guo2
1Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, Beijing, China.
Insights
Primary hepatolithiasis in children is rare and often incidentally discovered. Conservative observation is a safe approach, with most children not requiring surgery during childhood.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Medical Diagnostics
Background:
- Primary hepatolithiasis in adults typically presents with severe symptoms requiring surgical intervention.
- Limited research exists on pediatric primary hepatolithiasis.
Purpose of the Study:
- To evaluate the clinical characteristics and prognosis of primary hepatolithiasis in hospitalized children.
- To assess the outcomes of conservative management in pediatric cases.
Main Methods:
- Retrospective cohort study of 106 hospitalized children diagnosed with primary hepatolithiasis.
- Data collected from electronic medical records (2010-2021).
- Prognosis evaluated via outpatient ultrasounds and telephone interviews.
Main Results:
- Primary hepatolithiasis was incidentally detected by ultrasound in 1.7/10,000 children.
- The mean age at diagnosis was 9.3 years, with a male predominance.
- The right lobe was predominantly affected (75.5%); all patients received conservative observation.
- Follow-up in 73.6% of patients showed 5.1% experienced intermittent abdominal pain.
- Stones remained present in 85% of patients with follow-up ultrasounds.
Conclusions:
- Pediatric primary hepatolithiasis is rare and often asymptomatic, discovered incidentally.
- Conservative management is suitable for children with primary hepatolithiasis.
- Surgical intervention is typically not required in childhood for this condition.
Abstract:
The purpose of this study is to evaluate the clinical characteristics and prognosis of primary hepatolithiasis in hospitalized children. This retrospective cohort study included 106 hospitalized patients with primary hepatolithiasis at Beijing Children's Hospital. Clinical data were derived from electronic inpatient (2010-2021) and outpatient (2016-2021) medical records. The prognosis was evaluated by outpatient ultrasounds after discharge and telephone interviews performed in December 2022. Intrahepatic bile duct stones in patients enrolled in the study were all found incidentally by abdominal ultrasound during hospitalization, with an incidence of 1.7 per 10,000 hospitalized children. The mean age at diagnosis was 9.3 ± 3.6 years, with male predominance (69/106, 65.1%). The right lobe of the liver (80/106, 75.5%) was preferentially affected. All patients underwent conservative observation. Seventy-eight patients (78/106, 73.6%) were followed up with a mean follow-up age of 17.1 ± 5.0 years, and 4 (4/78, 5.1%) had intermittent abdominal pain. From 2016 to 2021, 32 patients were diagnosed with primary hepatolithiasis, and follow-up abdominal ultrasounds were performed in 20 of them (20/32, 60.0%) with a median time of 2.1 (0.1, 3.5) years. The stones were present in 17 patients (17/20, 85.0%).
Conclusion:
Primary hepatolithiasis in hospitalized children is rare, almost found accidentally; mostly affects the right lobe of the liver; and can be conservatively observed without surgical treatment in childhood.
What Is Known:
• Primary hepatolithiasis in adults often presents with severe clinical symptoms and requires hepatectomy.. • There are few studies on primary hepatolithiasis in children.
What Is New:
• Primary hepatolithiasis in children is mostly found accidentally by abdominal ultrasound without associated symptoms during hospitalization. • Children with accidental primary hepatolithiasis can be conservatively observed without surgical treatment in childhood.
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