TITLE:
A Prospective Study of Cholilithiasis in Children
AUTHORS:
Raiees Ahmad, Alfer Nafae, Shahnawaz Bashir, Pervaze Salam, Qayoom Khan, Malik Suhail, Umer Mushtaq, Javid Ahmad
KEYWORDS:
Peadiatric Cholelithiasis, Symptomatic Cholelithiasis, Peadiatric Age Group, Gallbladder Stones
JOURNAL NAME:
Surgical Science,
Vol.6 No.3,
March
26,
2015
ABSTRACT: Background: Gallstones are generally
uncommon in infants and children. Formation of gallstone is a very poorly
understood phenomenon. In general, the risk factors for cholithiasis in infants
include patients who are ill, are receiving hyperalimentation, are premature,
have congenital anomalies and have necrotizing enterocolitis. Children aged 1 -
5 years most frequently have hemolysis as the underlying condition [1]. Materials and Methods: From Jan 2012 to Feb 2014, a study
entitled “A Prospective Study of Cholelithiasis in Children” was conducted in
Postgraduate Department of General Surgery Govt. Medical College Srinagar. The
patients selected for the study were in the age group of 1 to 14 years of
either sex. There were a total of 141 cases, out of which only 38 had
ultrasound documented gallstones. All the patients included in the study were
evaluated for prevalence, clinical presentation, and pathological features of
gallstones, and were analysed for metabolic causes of gallstones. Results: The
prevalence of chliothiasis in symptomatic patients was found to be 26.95%
higher than the prevalence of gallstones in children in other parts of world,
also the mean age of presentation was 9.3 years ranging from 6 - 14 years. Male
to female ratio was 3:2 and male predominance was found in all age groups
contrary to female predominance in adults. Most common presenting symptom was
right upper quadrant pain followed by vomiting and nausea similar to
presentation of symptomatic gallstones in adults. 4 patients had a positive
family history of cholithiasis in the first degree relatives; 25 (65.7%)
patients had no underlying risk factor for gallstones contrary to presumption
that gallstones in children are mostly secondary to some hematological disorder
or other predisposing factors. Chronic cholecystities was found in 81% of
patients with gallstones and composition of gallstones retrieved was different
from those of adult gallstones with calcium carbonate gallstones relatively
common in children but composition of black and brown stones was almost similar
to adult stones. Conclusion: Gallstone disease was increasingly gaining
recognition in peadiatic practice due to significant documented increase in
non-heamolytic cases over the last two decades. The observed gallstones prevalence,
clinical presentation, pathological features of gallstones, and analysed
metabolic causes of gallstones in children are different from those stones
found in adults. The results of our study demonstrated that gallstones and
gallstone related complications in peadiatic populations were different from
the adult gallstone disease and there was an increase in prevalence of
gallstones in children with no under lying risk factor for gallstones, and
surgery remained the corne stone of treatment for peadiatric cholithiasis as in
adults.