Advertisement

Pediatric Surgery International

, Volume 35, Issue 5, pp 569–574 | Cite as

Adolescent gallstones—need for early intervention in symptomatic idiopathic gallstones

  • M. Sarrami
  • W. Ridley
  • S. Nightingale
  • T. Wright
  • R. KumarEmail author
Original Article

Abstract

Background and aim

Currently, there is a paucity of the literature describing the natural history of cholelithiasis (CL) and choledocholithiasis (CDL) in adolescent children. This study aims to analyse the changing demographics of paediatric and adolescent gallstones.

Methodology

Retrospective review of all children (Age 0–18 years) presenting with symptomatic gallstones over the last 15 years (2002–2017) at a single tertiary institution. Demographics, diagnostic and therapeutic information were collected, with a 5-year median follow-up. Statistics were accomplished by Chi-squared analysis of trend and Student t test.

Results and discussions

188 children were seen with symptomatic CL. In the 0–11-year-old group, there were 13 females and 16 males (0.8: female to male ratio). There were 130 females and 29 males in the 12–18-year-old group (4.5:1 female to male ratio). The mean weight at presentation was 81.78 kg and the median age was 16 years. Idiopathic gallstones were found in 131 patients (82%). 137 required cholecystectomy (86%) and ERCP was required in 32 patients (20%). 48 adolescents (30.2%) with gallstones had an associated CDL, compared to six children (20%). All of the adolescent patients with CDL had idiopathic gallstones. Gallstone pancreatitis was noted in eighteen adolescents (11%) and one child (3%). We analysed the ideal time to operate on adolescent patients with symptomatic gallstones using the relationship between the length of delay from initial diagnosis to definitive management of CDL and incidence of complications. The analysis demonstrated that for every 10 days treatment was delayed, the risk of subsequent presentations with a symptomatic episode was increased by 5% (p = 0.0004).

Conclusion

The current trend of gallstones in adolescent children seems to be a disease primarily of adolescent girls. Symptomatic idiopathic gallstones in adolescents are associated with high rates of common bile duct obstruction and pancreatitis and consequently warrant an early cholecystectomy for all adolescents.

Level of Evidence

Level IV Treatment Study.

Keywords

Gallstones Adolescent Complications Children 

Notes

References

  1. 1.
    Kumar R, Nguyen K, Shun A (2000) Gallstones and common bile duct calculi in infancy and childhood. ANZJ Surg 70(3):188–189CrossRefGoogle Scholar
  2. 2.
    Herzog D, Bouchard G (2008) High rate of complicated idiopathic gallstone disease in paediatric patients of a North American tertiary care centre. World J Gasteroenterol 14:1544–1548CrossRefGoogle Scholar
  3. 3.
    Svensson J, Makin E (2012) Gallstone disease in children. Semin Pediatr Surg 21:255–265CrossRefGoogle Scholar
  4. 4.
    Kratzer W, Mason RA, Kachele V (1999) Prevalence of gallstones in sonographic surveys worldwide. J Clin Ultrasound 27:1–7CrossRefGoogle Scholar
  5. 5.
    Shaffer EA (2005) Epidemiology and risk factors for gallstone disease: has the paradigm changed in the 21st century? Curr Gastroenterol Rep 7:132–140CrossRefGoogle Scholar
  6. 6.
    Wesdorp I, Bosman D, de Graaff A, van der Blij F, Taminiau J (2000) Clinical presentations and predisposing factors of cholelithaisis and sludge in children. J Pediatr Gastroenterol Nutr 31(4):411–417CrossRefGoogle Scholar
  7. 7.
    Mehta S, Lopez ME, Chumpitazi BP et al (2012) Clinical characteristics and risk factors for symptomatic pediatric gallbladder disease. Pediatrics 129:e82–e88CrossRefGoogle Scholar
  8. 8.
    Bogue CO, Murphy AJ, Gersle JT et al (2010) Risk factors, complications, and outcomes of gallstones in children: a single-centre review. J Pediatr Gastroenterol Nutr 50:303–308CrossRefGoogle Scholar
  9. 9.
    Skelton JA, Cook SR, Auinger P et al (2009) Prevalence and trends of severe obesity among US children and adolescents. Acad Pediatr 9:322–329CrossRefGoogle Scholar
  10. 10.
    Ogden CL, Carroll MD, Kit BK, Flegal KM (2012) Prevalence of obesity and trends in body mass index among US children and adolescents, 1999–2010. J Am Med Assoc 307(5):483–490CrossRefGoogle Scholar
  11. 11.
    National Center for Health Statistics. Health, United States, 2011: With Special Features on Socioeconomic Status and Health. Hyattsville, MD; U.S. Department of Health and Human Services; 2012Google Scholar
  12. 12.
    Friesen CA, Roberts CC. Cholelithiasis (1989) Clinical characteristics in children. Case analysis and literature review. Clin Pediatr (Phila) 28(7):294–298CrossRefGoogle Scholar
  13. 13.
    Attasaranya S, Fogel EL, Lehman GA. Choledocholithiasis, ascending cholangitis, and gallstone pancreatitis. Med Clin N Am. 2008 Jul 1;92(4):925–960Google Scholar
  14. 14.
    Miltenburg DM, Schaffer R III, Breslin T, Brandt ML (2000) Changing indications for pediatric cholecystectomy. Pediatrics 105(6):1250–1253CrossRefGoogle Scholar
  15. 15.
    Holcomb GW Jr, O’Neill JA Jr, Holcomb GW III (1980) Cholecystitis, cholelithiasis and common duct stenosis in children and adolescents. Ann Surg 191(5):626–635CrossRefGoogle Scholar
  16. 16.
    Kaechele V, Wabitsch M, Thiere D et al (2006) Prevalence of gallbladder stone disease in obese children and adolescents: influence of the degree of obesity, sex, and pubertal development. J Pediatr Gastroenterol Nutr 42(1):66–70CrossRefGoogle Scholar
  17. 17.
    Koivusalo AI, Pakarinen MP, Sittiwet C et al (2010) Cholesterol, non-cholesterol sterols and bile acids in paediatric gallstones. Dig Liver Dis 42(1):61–66CrossRefGoogle Scholar
  18. 18.
    Lugo-Vicente HL (1997) Trends in management of gallbladder disorders in children. Pediatr Surg Int 12:348–352CrossRefGoogle Scholar
  19. 19.
    Reif S, Sloven DG, Lebenthal E (1991) Gallstones in children: characterization by age, etiology and outcome. Am J Dis Child 145:105–108CrossRefGoogle Scholar
  20. 20.
    Wang HH, Liu M, Clegg DJ, Portincasa P, Wang DQ (2009) New insights into the molecular mechanisms underlying effects of estrogen on cholesterol gallstone formation. Biochim Biophys Acta 1791(11):1037–1047CrossRefGoogle Scholar
  21. 21.
    Debray D, Pariente D, Gauthier F, Myara A, Bernard O (1993) Cholelithiasis in infancy: a study of 40 cases. J Pediatr 122(3):385–391CrossRefGoogle Scholar
  22. 22.
    Freedman DS, Dietz WH, Srinivasan SR, Berenson GS (1999) The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Pediatrics 103(6 Pt 1):1175–1182CrossRefGoogle Scholar
  23. 23.
    American Diabetes Association (2000) Type 2 di- abetes in children and adolescents. Pediatrics 105(3 Pt 1):671–680CrossRefGoogle Scholar
  24. 24.
    Mallory GB Jr, Fiser DH, Jackson R (1989) Sleep- associated breathing disorders in morbidly obese children and adolescents. J Pediatr 115(6):892–897CrossRefGoogle Scholar
  25. 25.
    Quiros-Tejeira RE, Rivera CA, Ziba TT et al (2006) Risk for nonalcoholic fatty liver disease in Hispanic youth with BMI ≥ 95th percentile. Hepatology 44(2):228–236Google Scholar
  26. 26.
    Bennion LJ, Grundy SM (1975) Effects of obesity and caloric intake on biliary lipid metabolism in man. J Clin Invest 56:996–1011CrossRefGoogle Scholar
  27. 27.
    Dittrick GW, Thompson JS, Campos D et al (2005) Gallbladder pathology in morbid obesity. Obes Surg 15:238–242CrossRefGoogle Scholar
  28. 28.
    Marschall HU, Einarsson C (2007) Gallstone disease. J Intern Med 261:529–542CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • M. Sarrami
    • 1
  • W. Ridley
    • 2
  • S. Nightingale
    • 3
    • 4
  • T. Wright
    • 5
  • R. Kumar
    • 6
    Email author
  1. 1.School of Medicine and Population HealthUniversity of NewcastleNewcastleAustralia
  2. 2.School of Rural MedicineUniversity of New EnglandArmidaleAustralia
  3. 3.Department of GastroenterologyJohn Hunter Children’s HospitalNewcastleAustralia
  4. 4.GrowUpWell Priority Research CentreUniversity of NewcastleNewcastleAustralia
  5. 5.Department of General SurgeryJohn Hunter HospitalNewcastleAustralia
  6. 6.Department of Paediatric SurgeryJohn Hunter Children’s HospitalNewcastleAustralia

Personalised recommendations