Pathogenesis and Symptomatology of Cholelithiasis in Childhood

Abstract

Questions: How may gallstones develop if there is no hemolytic disorder and no malformation or alteration of the gallbladder and cystic ducts? Was there a change in the incidence of stones and the assignment of the patients to different age groups? The literature gives answers to these questions on the basis of only few cases. Therefore, a relatively large prospective database of collected cases during 30 years shall be used to give additional answers. Methods: The data are derived from 111 children with symptomatic gallstones without hemolytic diseases. 109 of them required operative therapy. They were examined preoperatively and postoperatively maximum during 30 years of follow-up as well according to a defined program. This program includes taking the patient’s history, evaluation of clinical, radiological including sonographical examination, exclusion of hemolytic primary diseases, histological investigation of intraoperatively gained specimens of the gallbladder, and the spectroscopic qualitative as well as semiquantitative analysis of stones and bile. Results: (1) The qualitative and quantitative composition of the stones is different in the four age groups. (2) The causes of lithogenesis are different in the four age groups. (3) Children with long-term TPN, after cardiopulmonary bypass operations, after extended small bowel resection, suffering from obesity, and girls using hormonal contraception are at risk of developing gallstones. We recommend to observe these patients by repeated ultrasound controls for gallstone formation during a minimum of 10 years. (4) Malformations and pathological alterations of the gallbladder are rare causes for increased lithogenity. The gallbladder appeared morphologically normal in 61% of patients with symptomatic gallstones. (5) An increased frequency of gallstones during the last 30 years was only observed in the age group under 1 year.

Gallstone disease in children

“…However, the prevalence of gallstones among obese children and adolescents was shown to be quite high (2% of 493 children) in a recent study (15). Studies on cholelithiasis in children have shown a bimodal distribution, with a small peak in infancy and a steadily rising incidence from early adolescence onwards (11,16). Boys and girls are equally affected in early childhood, but as in adults, a clear female preponderance emerges during adolescence.…”

“…Black pigment stones are formed due to supersaturation of bile with calcium bilirubinate and are seen in hemolytic disorders and in association with total parenteral nutrition. Brown pigment stones are associated with infection and biliary stasis and form more often in the bile ducts than in the gallbladder (16).…”

Coristoma pancreático en la vesícula biliar: Reporte de dos casos

“…La patología primaria, que podría potencialmente constituir la causa de la colelitiasis en estos pacientes no fue identificada; ellos no tenían enfermedades hemolíticas, malformaciones vesiculares, no fueron sometidos a nutrición parenteral total o a resección subtotal del ileón, condiciones consideradas factores de riesgo para el desarrollo de colelitiasis en la infancia 15 , además los síntomas de la paciente se iniciaron a los 13 años de edad, nunca estuvo embarazada y no utiliza anticonceptivos orales. Según Schweizer et al 15 , la patología primaria en pacientes pediátricos con colelitiasis y sin enfermedades hemolíticas no es detectable en 31% de los niños entre 1 y 5 años de edad y en 52% de los pacientes entre 11 y 15 años de edad, estas cifras son relevantes debido a que este estudio constituye la serie más importante publicada a la fecha sobre colelitiasis en pacientes pediátricos.…”

“…Según Schweizer et al 15 , la patología primaria en pacientes pediátricos con colelitiasis y sin enfermedades hemolíticas no es detectable en 31% de los niños entre 1 y 5 años de edad y en 52% de los pacientes entre 11 y 15 años de edad, estas cifras son relevantes debido a que este estudio constituye la serie más importante publicada a la fecha sobre colelitiasis en pacientes pediátricos. En la misma serie, no se encontraron coristomas pancreáticos en las vesí-culas de 109 pacientes operados por colelitiasis, este hecho remarca la rareza del páncreas heterotópico en la vesícula biliar.…”

Evaluation and management of cholelithiasis in children: a hospital based study

“…6 As is seen in adults, gallstones in adolescent girls are also more often idiopathic. 7 Most common presentation is typical right upper quadrant pain (50%); and in 25% there may be non-specific abdominal symptoms including poorly localized abdominal pain and nausea. Around 20% of cases are asymptomatic (incidentally detected stone).…”