Publication:

A study of cholelithiasis in adolescent children attending a tertiary care hospital

Background Cholelithiasis is relatively rare in children and there is paucity of information about cholelithiasis in adolescent children. There is no consensus among pediatricians and pediatric surgeons regarding the management of cholelithiasis in adolescents. Cholelithiasis is increasingly diagnosed due to wide spread use of ultrasound. This has led to increased detection of asymptomatic cholelithiasis. The profile of cholelithiasis in adolescents is analyzed in this study.

Methods Medical records of patients with the discharged diagnosis of cholelithiasis from January 2010 to March 2015 were analyzed. Sixty children were enrolled in the study. Patients were divided into symptomatic and asymptomatic group depending upon the clinical presentation.

Results Among the 60 children, 43 (71.7%) patients had no identifiable risk factor for cholelithiasis. Predominant identifiable risk factor was ceftriaxone use in 7 (11.7%) patients. Forty four (73%) were nutrionally normal, fifty one (85%) patients were symptomatic and nine (9%) patients were asymptomatic. Anemia was noticed in 46 (76.7%) patients. Laparoscopic cholecystectomy was done for 29 (48.3%) patients, other surgical procedures in 7 (11.6%) patients and 23 (38.3%) patients were treated conservatively. Seven out of 9 patients in the asymptomatic group and 14 of symptomatic group treated conservative management had spontaneous resolution of cholelithiasis.

Conclusions Gallstones need not be always present with symptoms and there is a significant number of children who were asymptomatic. Majority of the patients do not have identifiable risk factors. Most of the children were underweight. Laparoscopic cholecystectomy was advised for majority of symptomatic cholelithiasis.