Cholecystectomy in children with sickle-cell disease

Al-Salem, Ahmed H.; Nangalia, R.; Kolar, Kadappa; Qaisaruddin, Syed; Al-Dabbous, Ibrahim A.; Al‐Jam'a, Ali H.

doi:10.1007/bf00176389

Cited by 17 publications

(10 citation statements)

References 17 publications

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“…2 This is in comparison with 14% to 30% in SCD patients with gallstones. 3,[10][11][12] In a previous study, we reported a frequency of CBD stones of 30% in children with SCD undergoing cholecystectomy, 3 and based on this high frequency we recommended routine intraoperative cholangiogram. This may necessitate CBD exploration and open transduodenal sphincterotomy and sphincteroplasty.…”

Section: Discussionmentioning

confidence: 96%

“…Recently, however, and as a result of the routine use of ultrasonography in the evaluation of children with abdominal pain, biliary and pancreatic diseases are being diagnosed more often in children, 2 especially in areas where hemolytic diseases which are known to be associated with increased frequency of cholelithiasis and choledocholithiasis are common. [3][4][5] The present study describes our experience with ERCP in the evaluation, diagnosis and treatment of pancreatobiliary disorders in children and demonstrates its value in the era of laparoscopic cholecystectomy.…”

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confidence: 88%

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The Role of ERCP in the Evaluation, Diagnosis and Therapy of Biliary and Pancreatic Diseases in Children

1999

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The role of endoscopic retrograde cholangiopancreatography (ERCP) for the investigation and treatment of biliary and pancreatic diseases is well established in adults.1 This, however, is not the case in the pediatric age group, because biliary and pancreatic diseases are less common in children. In addition to this problem is the lack of pediatric gastroenterologists who are skilled in performing ERCP in children. Recently, however, and as a result of the routine use of ultrasonography in the evaluation of children with abdominal pain, biliary and pancreatic diseases are being diagnosed more often in children, 2 especially in areas where hemolytic diseases which are known to be associated with increased frequency of cholelithiasis and choledocholithiasis are common. 3-5The present study describes our experience with ERCP in the evaluation, diagnosis and treatment of pancreatobiliary disorders in children and demonstrates its value in the era of laparoscopic cholecystectomy. Patients and MethodsOver a four-year period from September 1993 to August 1997, 34 consecutive children less than 18 years old had ERCP as part of their management at our hospital. The records of these patients were reviewed retrospectively for age, gender, indication for ERCP, pre-ERCP investigations, results, complications of ERCP and post-ERCP management.Informed, written consent for ERCP was obtained from the child's parent. All ERCPs were performed in the Radiology Department. For patients 10 years old and below, ERCP was performed under general anesthesia with nasotracheal intubation. In those older than 10 years, ERCP was done under sedation only. Patients with sickle cell disease were hydrated with intravenous fluids starting the night before the procedure, at a rate of 1½ their maintenance requirements, and blood transfusions were given when necessary to increase their Hb to 10-12 g/dL. With the patients properly sedated, using meperedine (1 mg/kg) and diazepam (0.1-0.2 mg/kg), the Olympus JF1 T20 side-viewing duodenoscope was used in all the patients. After visualization, the ampulla of Vater was cannulated with tapered catheters and the pancreatic and biliary ducts were visualized by fluoroscopy during injection of Hexabrix (320 mg was diluted to 50%). Appropriate radiographs were obtained in all cases. Where indicated, sphincterotomy was performed using 5F sphincterotome (Olympus). Common bile duct stone extraction was performed with basket and balloon catheters. During the procedure, all patients were monitored with pulse oximetry with a cardiorespiratory trolley at the bedside. ResultsThe 34 children who had ERCP at Qatif Central Hospital as part of their management over the four-year study period comprised 20 males and 14 females. Their ages ranged from 5-18 years (mean 14.5 years). Of the 34 patients, 29 (85.3%) had sickle cell disease (SCD). Their mean HbS level was 77.8% (range 66.1-90.7) and their mean HbF level was 21% (range 7.2-37). The indications for ERCP are shown in Table 1. Obstructive jaundice was the most common i...

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Section: Discussionmentioning

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confidence: 88%

The Role of ERCP in the Evaluation, Diagnosis and Therapy of Biliary and Pancreatic Diseases in Children

1999

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“…The incidence of common bile duct stones in sickle cell patients has been reported to reach 30% [1], and several patients may not have any preoperative symptoms or suspicion signs of choledocholithiasis on laboratory tests or ultrasound. Although exploration of the common bile duct can be performed with intraoperative cholangiography, we now feel comfortable also with intraoperative ultrasound, which, in experienced hands, is reliable and accurate, less invasive, and in many instances, complementary to intraoperative cholangiography.…”

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Laparoscopic surgery in sickle cell disease

et al. 2002

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“…[6][7][8][9] When performed separately, elective cholecystectomy and splenectomy have been shown to be safe and effective in patients with SCD. [6][7][8][9][10] Should cholecystectomy be performed concomitantly with splenectomy in patients with SCD?…”

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confidence: 99%

“…19,20 Cholecystectomy is the treatment of choice in these patients, even if gallstones are asymptomatic, as with improved care there is increased life expectancy and so a likely chance of developing gallstone-related complications. 10 To avoid these complications and operating on these patients on an emergency basis, we advocate elective cholecystectomy even for asymptomatic gallstones. Because of the increased incidence of cholelithiasis in patients with SCD, it is not uncommon that patients undergoing splenectomy are found to have gallstones which can be either symptomatic or asymptomatic.…”

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Experience of Concomitant Splenectomy and Cholecystectomy in Patients with Sickle Cell Disease

et al. 1998

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Sickle cell disease (SCD) is one of the commonly inherited hemoglobinopathies in the Eastern Province of Saudi Arabia, 1,2 which is known to have an increased frequency of cholelithiasis. 3 Patients with SCD from the Eastern Province are known to have splenomegaly that persists into an older age group, and in some into adult life. 4,5 This is known to be associated with complications which necessitate splenectomy.6-9 When performed separately, elective cholecystectomy and splenectomy have been shown to be safe and effective in patients with SCD.6-10 Should cholecystectomy be performed concomitantly with splenectomy in patients with SCD? Patients and MethodsA total of 112 patients had splenectomy for various hematological diseases at Qatif Central Hospital, over a period of 10 years, from 1986 to 1996. The most common indication for splenectomy was SCD. Seventy-four patients (66%) with SCD had splenectomy. Of these, 17 (23%) had concomitant splenectomy and cholecystectomy. The charts of these patients were reviewed for age at operation, sex, indication for splenectomy, whether gallstones were symptomatic or incidental, postoperative complications and outcome. The results were compared with the remaining patients with SCD, who only had splenectomy.The diagnosis of SCD was made on the basis of a positive sickling test and hemoglobin electrophoresis (Helena Laboratories Super Z Electrophoresis Kit). The histology of the spleen and gallbladder were obtained from the histopathology report. Preoperatively, all patients were hydrated with intravenous fluids at 1.5 times their maintenance rate, starting the night of the operation and continued postoperatively, until resuming full oral intake. Where necessary, blood transfusions were given preoperatively to restore their Hb to 10-12 g/dL and their hematocrit to 30%-40%. No exchange blood transfusions were performed. All patients received polyvalent Pneumovax (0.5 mL of PMY-immune 23, Lederle), as well as prophylactic antibiotics. ResultsOf seventy-four patients with SCD who had splenectomy, 17 (23%) had concomitant splenectomy and cholecystectomy. There were nine females and eight males. Their ages ranged from 12-60 years (mean 24.4 years). Their HbS ranged from 67%-92.3% (mean 77%), and their HbF ranged from 6.2%-33% (mean 21.2%). Their demographic data, as well as indications for splenectomy and cholecystectomy, are shown in Table 1. The indications for splenectomy were hypersplenism in seven, recurrent splenic sequestration crisis in eight, and splenic abscess in two patients. In 11 patients gallstones were symptomatic in the form of recurrent right upper quadrant abdominal pain, while in the remaining 6 (35.3%), gallstones were discovered incidentally during routine ultrasound investigation.Histology of the spleens showed features of congestive splenomegaly in 15 patients with sclerosis and hemosiderosis in some of them, as well as sickling of red blood cells. In the remaining two patients with splenic abscess, there was evidence of ischemic infarction and abscess for...

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Cholecystectomy in children with sickle-cell disease

Cited by 17 publications

References 17 publications

The Role of ERCP in the Evaluation, Diagnosis and Therapy of Biliary and Pancreatic Diseases in Children

The Role of ERCP in the Evaluation, Diagnosis and Therapy of Biliary and Pancreatic Diseases in Children

Laparoscopic surgery in sickle cell disease

Experience of Concomitant Splenectomy and Cholecystectomy in Patients with Sickle Cell Disease

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