DOI: https://dx.doi.org/10.18203/2349-2902.isj20221157
Published: 2022-04-26

Cholelithiasis-diagnostic approach: are clinical presentations in children different?

Theyveeka Selvy Rajoo, Janakan Naidu, Senevahsan Naidu, Julian M. Ramli, Azuddin M. Khairy

Abstract


Cholecystitis has been considered an uncommon entity in children, but it’s incidence is reportedly increasing which may be attributed to widespread use of diagnostic imaging (ultrasonography). A healthy 11-year-old female Indian child presented to the emergency department with a chief complaint of abdominal pain. The pain was at the epigastric region and accompanied with vomiting. As per the complete examination and findings, a diagnosis of constipation colic was made. A month later, the patient presented with the same chief complaint, but general physical examination revealed tenderness at the right hypochondrium, and Murphy’s sign was positive. Upon performing an abdominal ultrasound, multiple small gallstones were noted in an otherwise normal gallbladder. No biliary obstruction was seen. A diagnosis of acute cholecystitis was made. Patient was then admitted and treated with a course of antibiotics. The incidence of cholelithiasis in children has not been sufficiently studied. The incidence of cholecystitis in India was found to be 0.3% with the incidence in age group 0-10 being less than 0.1%. In contrast to adult cholecystitis, it has been found that there is female predominance of cholecystitis in children. In children, 20% to 50% gallstones are radiopaque. Unknown causes are still prevalent in stone formation. Hence, the purpose of this paper was to increase awareness about the diagnosis of cholelithiasis in children. The probability of cholecystitis in children should not be ignored. Cholelithiasis should always be considered as a differential diagnosis when children present with complaints of abdominal pain.


Keywords


Children, Cholelithiasis, Cholecystitis, Gallstones

Full Text:

PDF

References


Bogue CO, Murphy AJ, Gerstle JT, Moineddin R, Daneman A. Risk factors, complications, and outcomes of gallstones in children: a singlecenter review. J Pediatr Gastroenterol Nutr. 2010;50(3):303-8.

Gaharwar A. Factors favouring cholelithiasis in North Indian Population. IOSR J Pharm. 2013;3(5):1-3.

Poddar U. Gallstone disease in children. Indian Pediatr. 2010;47(11):945-53.

Barthel ER, Pierce JR, Zmora O, Harlan SR, Russell S, Shin C. Calcified gallstone in a 3year-old boy: a case report. BMC Res Notes. 2012;5:433.

Ganesh R, Muralinath S, Sankarnarayanan VS, Sathiyasekaran M. Prevalence of cholelithiasis in children-a hospital-based observation. Indian J Gastroenterol. 2005;24(2):85.

Gowda DJ. Laparoscopic cholecystectomy for cholelithiasis in children. J Indian Assoc Pediatr Surg. 2009;14(4):204-6.

Zenon P, Maja A, Miro J, Vanda Z, Ranka D, Ivo J. Gallbladder disease in children: a 20-year single-center experience. Indian Pediatr. 2019;56.

Filiz S, Yavuz SK, Fatma S, Tugba K, Selim D, Mustafa A, et al. Gallstones in childhood: etiology, clinical features, and prognosis. Eur J Gastroenterol Hepatol. 2016;28(12):1468-72.

Mehta S, Lopez ME, Chumpitazi BP, Mazziotti MV, Brandt ML, Fishman DS. Clinical characteristics and risk factors for symptomatic pediatric gallbladder disease. Pediatrics. 2011;129(1):82-8.

Gaurav G, Balija S, Sangeeta G, Vishrut N, Prateek S. Clinical profile, evaluation and management of gallstone disease in children in a rural referral tertiary centre. J Clin Diagnost Res. 2018;12(3):9-12.

Millar AJW. Surgical disorders of the liver and bile ducts and portal hypertension. In: Kelly DA, eds. Disease of the liver and biliary system in children. 3rd ed. UK: Wiley-Blackwell publication; 2008: 433-74.