The Specific features of pediatric cholelityhiasis. A Literature review.

Abstract

Cholelithiasis is the occurrence of one or several gallstones in the gallbladder. It can be complicated by choledocholithiasis, acute or chronic cholecystitis, cholangitis, biliary pancreatitis, biliary ileus, etc. The causes of this disorder in the pediatric population can be hemolytic (hereditary spherocytosis, thalassemia, or sickle cell anemia) or non-hemolytic - other hereditary disorders such as cystic fibrosis, Wilson’s disease or ileum disorders, total parenteral nutrition, use of certain medication, choledochal cysts, organ transplantation and, in adolescence, those similar to adult patients (obesity). Most gallstones found in children are cholesterol or pigmented gallstones. There are many diagnostic imaging methods for objectifying gallstones and their complications (such as choledocholithi- asis that requires ERCP). There are also some differential diagnoses that should be taken into consideration before treatment (biliary dyskinesia, Odii sphincter dysfunction, neonatal jaundice, cholestasis, pediatric cholecystitis, pediatric pancreatitis and pancreatic pseudocysts, as well as pediatric pyelonephritis). The first line of treatment of cholelithiasis is diet, saline infusions and medication, and if cholelithiasis is symptomatic and/or complicated, then cholecystectomy is recommended. The surgical approach may be an open procedure or laparoscopy. Some studies show that injuries of the bile ducts are more common in laparoscopic treatment of pediatric cholelithiasis, but nevertheless it has been shown that with an experienced team and good preparation it is the gold standard in the treatment of pediatric cholelithiasis. We present a comprehensive review of the literature on the clinical presentation, pathophysiology, diagnostic evaluation, and management of cholelithiasis in the pediatric population. Laparoscopic cholecystectomy is safe and effective in children, and shows the same advantages reported in adults.