Cholelithiasis
During the past two decades, cholelithiasis has been recognized in increasing numbers of paediatric patients. This diagnosis should be considered in the event of upper abdominal complaints, particularly when one or more risk factors are evident. The etiology may be unknown or may be related to risk factors, including haemolytic conditions. In recent years, it has become evident that approximately 80% of gallstones in children are not due to haemolytic disease and that the remaining 20% are related to recurring haemolysis. The diagnosis of gallstones is best confirmed with ultrasonography.
Treatment
Cholecystectomy is the procedure of choice for symptomatic children with cholelithiasis, regardless of age. Cholecystectomy is recommended for the asymptomatic child younger than 3 years of age when echogenic shadows have been present for at least 12 months following resumption of oral feedings or when the gallstones are radiopaque. Also, cholecystectomy is advised for asymptomatic children who are older than 3 years of age if ultrasonographic studies confirm that echogenic foci with shadowing are true stones and not echogenic sludge. Complications of common bile duct obstruction, pancreatitis, perforation with bile peritonitis, and life-threatening sepsis may thus be prevented. Morbidity and mortality following cholecystectomy are expected to be relatively low in the paediatric age group.