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The significance of biliary sludge in children with sickle cell disease
1Division of Pediatric Surgery, Department of Surgery, Qatif Central Hospital, Qatif, Saudi Arabia.
Insights
Gallstones and biliary sludge are common in children with sickle cell disease. Regular ultrasound follow-up is recommended for children with sludge, with cholecystectomy advised for those developing gallstones or symptoms.
Area of Science:
- Pediatric Gastroenterology
- Hematology
- Medical Imaging
Background:
- Sickle cell disease (SCD) is a genetic blood disorder associated with various complications.
- Cholelithiasis (gallstones) and biliary sludge are known potential complications in SCD patients.
Purpose of the Study:
- To prospectively evaluate the prevalence of cholelithiasis and biliary sludge in children with sickle cell disease.
- To assess the natural progression of biliary sludge and determine management recommendations.
Main Methods:
- Prospective abdominal ultrasound (US) examination.
- Study population: 305 children with sickle cell disease (aged 1-18 years).
- Follow-up US assessments for children with initial diagnosis of biliary sludge.
Main Results:
- Prevalence of gallstones was 19.7% (60/305).
- Biliary sludge was present in 16.4% (50/305).
- Of 35 children with sludge followed up, 65.7% developed gallstones, and 5 underwent cholecystectomy.
Conclusions:
- Children with sickle cell disease have a high prevalence of gallstones and biliary sludge.
- Regular ultrasound monitoring is crucial for children with biliary sludge.
- Elective cholecystectomy is recommended for symptomatic patients or those who develop gallstones.
Abstract:
The prevalence of cholelithiasis was studied prospectively by abdominal ultrasound (US) examination in 305 children with sickle cell disease aged 1-18 years (mean 10.45). Gallstones were present in 60 children (19.7%); an additional 50 had biliary sludge only (16.4%). On follow-up of 35 of the 50 children with sludge, 23 (65.7%) had developed gallstones and 5 had already had a cholecystectomy. Five continued to have sludge on follow-up while 7 were reported to have no sludge. Children with US evidence of sludge should be followed up regularly by US, and those who develop gallstones should undergo elective cholecystectomy. For those with biliary sludge only, we recommend elective cholecystectomy if there are hepatobiliary symptoms.