Primary choledocholithiasis after cholecystectomy without hyperbilirubinaemia in a child with sickle cell disease

Area of Science:

• Pediatric Gastroenterology
• Hematology
• Hepatobiliary Medicine

Background:

• Children with sickle cell disease (SCD) are prone to hepatobiliary issues due to chronic hemolysis and sickling.
• Choledocholithiasis in pediatric SCD typically arises from gallstones, but primary stones can occur.
• Prior cholecystectomy and normal bilirubin levels can impede diagnosis of biliary disease in SCD.

Purpose of the Study:

• To report an uncommon instance of primary choledocholithiasis in a pediatric patient with SCD.
• To emphasize the diagnostic challenges posed by normal bilirubin levels and a history of cholecystectomy.

Main Methods:

• Case report detailing clinical presentation, diagnostic workup, and management.
• Review of relevant literature on biliary tract pathology in pediatric sickle cell disease.

Main Results:

• A child with SCD and a history of cholecystectomy presented with abdominal pain and primary choledocholithiasis.
• Diagnostic delays were noted due to normal conjugated bilirubin levels.

Conclusions:

• Primary choledocholithiasis is a rare but possible diagnosis in children with SCD, even after cholecystectomy.
• Healthcare providers must maintain a high index of suspicion for biliary disease in SCD patients with abdominal pain, irrespective of bilirubin levels or prior surgery.