CHRONIC ACALCULOUS CHOLECYSTITIS IN CHILDREN

Abstract

28 The occurrence of acalculous cholecystitis (AC) in otherwise healthy children has not been well characterized. AIM: The goal of the current study was to describe the characteristics of pediatric patients with AC diagnosed by hepatobiliary scan with Lipomul challenge and to evaluate clinical outcome following cholecystectomy. METHODS: A retrospective chart review was performed on symptomatic patients with (1) hepatobiliary scans demonstrating abnormal response to Lipomul (i.e. gallbladder ejection fraction [GBEF] <35%) (2) abdominal ultrasounds without evidence of stones, and (3) who underwent cholecystectomy. RESULTS: Ten patients (7 female, 3 male; age:13.7 ± 3.7 yrs [mean ± SD]) were identified. All had a history of right upper quadrant (RUQ) pain, 70% had classic biliary colic, and the duration of symptoms was 6.6 ± 6.7 mos. The average GBEF following Lipomul was 17.1 ± 9.6%. There were two patients with evidence of echogenic sludge in the gallbladder by ultrasound, and only one patient had mildly elevated liver enzymes. Nine of ten patients had laparoscopic cholecystectomy, one patient's procedure was converted to an open cholecystectomy due to adhesions. There were no surgical complications. Histopathology of the gallbladder demonstrated chronic cholecystitis in 80% of cases. At follow up (10.0 ± 14.0 mos after surgery), 70% of patients were asymptomatic. Two patients had nausea, but resolution of pain, and the final patient continued to have RUQ pain. CONCLUSIONS: Chronic cholecystitis may be responsible for RUQ pain in children without gallstones. In addition, an abnormal GBEF after Lipomul challenge may be a useful tool in guiding the diagnosis and management of pediatric patients with AC.