37 - Biliary stone disease

Summary

Introduction

Over the past decade, cholelithiasis and choledocholithiasis have been diagnosed with increasing frequency during infancy and childhood. The increased rate of diagnosis may be related to a true rise in the incidence of the disease, or, more likely, to an enhanced ability to detect gallstones. The prevalence of gallstones in the pediatric population has been reported to be between 0.13% and 0.22%. However, in children who undergo an abdominal sonogram for abdominal pain, the incidence of gallstones and sludge has been reported to be as high as 1.9%.7 The mean age for cholelithiasis in pediatric patients is between 7 and 10 years. Most authors report a slight preponderance of boys among pre-adolescents with cholelithiasis. However, this trend is completely reversed in the adolescent group.

Although underlying hematologic diseases such as sickle cell anemia, hereditary spherocytosis and thalassemia have been implicated as major predisposing factors for childhood cholelithiasis, the majority of gallstones in children are believed to be idiopathic. Several series suggest that only 20% of gallstones are related to hematologic diseases. Other putative risk factors for childhood cholelithiasis include: total parenteral nutrition; ileal resection; ileal disorders; obesity; family history of gallstones; cystic fibrosis; biliary tract anomalies and medications (birth control pills, cyclosporin, ceftriaxone). Gallstones can be classified as pigment, cholesterol or mixed-type stones. Pigment stones are usually detected during infancy and early childhood, and typically are associated with hemolytic disorders. In contrast, cholesterol and mixed-type stones are more commonly seen in adolescents.