Abstract

Gall stones is a known entity in adults, but are considered uncommon in pediatric population, however in the recent years, mainly with wide spread use of ultrasonography, cholelithiasis in children is being frequently reported. Etiology of gall stones in children is not similar to adults. Pigment stones are the most frequently seen in children with hemolytic disease as the most common cause, however with the increase in obesity in children there is also rise in cholesterol stones. Many other causes like drugs, congenital hepatobiliary malformation and genetic causes are to be kept during evaluation of gall stones. Management of gall stones need a proper and timely work up for the causes of cholelithiasis is necessary in children. Surgical management with laparoscopic cholecystectomy is the treatment of choice in most of the cases however the timing of surgery should be optimized case to case basis.

Highlights

  • Gall stones is a known entity in adults, but are considered uncommon in pediatric population with a prevalence of 0.13% to 0.2% [1] and no clear approach has been defined

  • The bilirubin which is produced by hemolysis, further conjugated in the liver and excreted in the intestine as urobilinogen which is further absorbed and excreted multiple times through the enterohepatic circulation of bile.in hemolysis the abundance of urobilinogen in the bile leads to precipitation which may become calcified, which if continuous leads to gall stone formation [24]

  • It is recommended that children with biliary symptoms or cholelithiasis, as well as unclear ultrasonography of the bile ducts with a BMI of 23 or more should routinely undergo Magnetic resonance cholangiopancreatography (MRCP) to rule out choledocholithiasis

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Summary

Introduction

Gall stones is a known entity in adults, but are considered uncommon in pediatric population with a prevalence of 0.13% to 0.2% [1] and no clear approach has been defined. In the recent years, mainly with wide spread use of ultrasonography, cholelithiasis in children is being frequently reported. Unlike adults the asymptomatic presentation is less likely in children (17–50%) [2, 3]. Etiology of gall stones in children is not similar to adults. Many studies have shown haemolytic diseases are the most common causes of cholelithiasis in children [20–30%], followed by other cause like obesity, total parenteral nutrition, ileal disease or resection, congenital hepatobiliary diseases, use of ceftriaxone and idiopathic [6]. Other causes like metabolic syndrome, PFIC (progressive familial intrahepatic cholestasis), choledochal cyst, biliary cirrhosis, prematurity, necrotizing enterocolitis (NEC), Wilson disease, congenital heart diseases, cystic fibrosis, should be considered

Pathogenesis
Biliary sludge
Cholesterol stones
Pigment stones
Hemolysis
Ceftriaxone-associated biliary pseudolithiasis
Genetics
Obesity
Total parenteral nutrition and cholelithiasis
Clinical features
Differential diagnosis of gall stones
Acute calculous cholecystitis
Common bile duct obstruction
Pancreatitis
Investigation
Management
Management of cholelithiasis in hemolytic disease
Findings
Prevention of gall stones

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