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

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-Schoenlein 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.