Risk Factors and Management Problems in Non-Hemolytic Cholelithiasis in Children

Authors

  • Didem Baskın Embleton Afyon Kocatepe University Medical Faculty
  • Ayşegül Bükülmez Afyon Kocatepe University Medical Faculty
  • Sezgin Yılmaz Afyon Kocatepe University Medical Faculty
  • Ahmet Ali Tuncer Afyon Kocatepe University Medical Faculty
  • Salih Çetinkurşun Afyon Kocatepe University Medical Faculty

Abstract

Objective: Present study has been conducted to evaluate themanagement of non-hemolytic cholelithiasis in children in a single center.

Methods: Children with non-hemolytic cholelithiasis between 2011 and 2016 were included in the study. Age, sex, risk factors, additional pathologies, symptoms at admittance, type of treatment given and results were examined retrospectively.

Results: Forty-four patients were included. Mean age was 9.31years. There were 19 male and 25 female patients. All patients admitted with abdominal pain and the diagnosis was made with ultrasonography.Risk factors/additional pathologies were as follows: previous surgery (n=6), previous antibiotic usage (n=5), cerebral palsy (n=1), Down syndrome (n=2), heart disease (n=2), Henoch-Schöenlein purpura (n=1), pancreatitis (n=1), obesity (n=2) and history of familial gall bladder stones (n=3). Seventy eight percent of the risk factors involved prior hospitalization and intravenous antibiotic usage.

In younger patients and patients with risk factors, oral ursodeoxycholic acid (UDCA) 10 mg/kg twice daily was used. UDCA treatment was effective in 37.5% of the patients.

Ten patients had cholecystectomy. They were older than 10 years. Chronic cholecystitis was present in all cholecystectomy specimens. After cholecystectomy, three patients still have intermittent abdominal pain and one has diarrhea attacks.

Conclusion:In patients that needed hospitalization and IV antibiotic use for other reasons, screeningfor the gall bladder stones may lead to early use of UDCA and dissolution of the stones.For parents and surgeons, the most comfortable age in children for cholecystectomy for persistent gall stones seems the age older than 10 years in our series.

Author Biographies

Didem Baskın Embleton, Afyon Kocatepe University Medical Faculty

Department of Pediatric Surgery

Ayşegül Bükülmez, Afyon Kocatepe University Medical Faculty

Department of Pediatrics

Sezgin Yılmaz, Afyon Kocatepe University Medical Faculty

Department of General Surgery

Ahmet Ali Tuncer, Afyon Kocatepe University Medical Faculty

Department of Pediatric Surgery

Salih Çetinkurşun, Afyon Kocatepe University Medical Faculty

Department of Pediatric Surgery

References

Dooki MRE, Norouzi A. Cholelithiasis in childhood: A cohort study in North of Iran. Iran J Pediatr 2013; 23:588-92.

Della Corte Ci Falchetti D, Nebbia G, Calacocci M, Pastore M, Francavilla R, Marcellini M, et al. Management of cholelithiasis in Italian children: a national multicenter study. World J Gastroenterol 2008; 14:1383-8.

Gökçe S, Yıldırım M, Erdoğan D. A retrospective review of children with gallstone: Single-center experience from Central Anatolia. Turk J Gastroenterol 2014; 25:46-53.

Kin HY, Kim SH, Cho YH. Pediatric cholecystectomy: Clinical significance of cases unrelated to hematologic disorders. PediatrGastroenterolHepatolNutr 2015;18:115-20.

Tsai J, Sulkowski JP, Cooper JN, Mattei P, Deans KJ, Minneci PC. Sensitivity and predictive value of ultrasound in pediatric cholecystitis. J Surgical Research 2013; 184:378-82.

Langballe KO, Bardram L. Cholecystectomy in Danish children. J Ped Surg2014; 49:626-30.

Campbell S, Richardson B, Mishra P, Wong M, Samarakkody U, Beasley S, et al. Childhood cholecystectomy in New Zealand: A multicenter national 10 year perspective. J Pediatr Surg. 2016;51:264-7.

Tannuri ACA, Leal AJG, Velhote MCP, Gonlçalves MEP, Tannuri U. Management of gallstone disease in children: A new protocol based on the experience of a single center. J PediatrSurg 2012; 47: 2033-8.

Stevensson J, Makin E. Gallstone disease in children. Seminars in Ped Surg 2012; 21: 255-65.

Guarino MPL, Cocca S, Altomare A, Emerenziani S, Cicala M. Ursodeoxycholic acid therapy in gallbladder disease, a story not yet completed. World JGastroenterol 2013; 19: 5029-34.

Rodriguez Rangel DA, Pinilla Orajenera AP, Bustacara Diaz M, Henao Garcia N, Lopez Cadena A, Montoya Camargo R, et al. Gallstones in association with the use of ceftriaxone in children. AnPediatr (Barc) 2014; 80:77-80.

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Published

29.03.2017

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Original Research

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