Asymptomatic Cholelithiasis in Children With Sickle Cell Disease

Abstract

Elective LC should be the gold standard in children with SCD and asymptomatic cholelithiasis to prevent the potential complications of biliary colics, acute cholecystitis, and choledocholithiasis, which lead to major risks, discomfort, and longer hospital stay.

Management of gallstone disease in children: a new protocol based on the experience of a single center

“…Some authors believe that it is indicated only in patients with comorbidities, particularly hemolytic anemias [12]. In the present series, we observed that significant proportion of all patients (25.1%) developed complications related to the presence of gallstones (eg, ACC, pancreatitis, choledocolithiasis), and the complication was the first sign of cholelithiasis.…”

“…In another publication, 10 of 14 initially asymptomatic patients with sickle cell disease became symptomatic and required surgery. In addition, the operative time, morbidity rate, and postoperative stay were greater among symptomatic patients who underwent cholecystectomy than in those who underwent the surgery when asymptomatic [12]. Another argument is that the presence of gallstones is a major risk factor for carcinoma of the gallbladder [13].…”

Asymptomatic Gallstones (AsGS) – To Treat or Not to?

“…In fact, biliary complications often precipitate veno-occlusive crises. Also, emergency surgery for complications is associated with significantly higher morbidity, mortality and increased hospital stay [25]. Elective, prophylactic cholecystectomy is thus recommended on diagnosis of GS before development of symptoms or complications.…”

Effects of Age and Sex on Sickle Cell Disease Avascular Necrosis

“…However, Koduri et al reported that silent AVN occurred in 41% children aged 4-28 years with the spine and shoulder being involved in 27% and 28% cases, respectively [18]. This indicates that there is an underestimation of AVN prevalence in children because of asymptomatic AVN or insensitive AVN investigation by using radiography [19]. Earlier studies on AVN prevalence in patients with SCD were grossly underestimated, particularly, since 47% and 79% patients with hip and shoulder disease, respectively had no symptoms at the diagnosis time [20] for that reason bone scintigraphy is recommended to detect the silent and the multifocal AVN [21].…”