A study of cholelithiasis in adolescent children attending a tertiary care hospital

Dinesh Kumar J., Anitha P., Divyashree V. S., Ramachandran P.


Background:Cholelithiasis is relatively rare in children and there is paucity of information about cholelithiasis in adolescent children. There is no consensus among pediatricians and pediatric surgeons regarding the management of cholelithiasis in adolescents. Cholelithiasis is increasingly diagnosed due to wide spread use of ultrasound. This has led to increased detection of asymptomatic cholelithiasis. The profile of cholelithiasis in adolescents is analyzed in this study.

Methods: Medical records of patients with the discharged diagnosis of cholelithiasis from January 2010 to March 2015 were analyzed. Sixty children were enrolled in the study. Patients were divided into symptomatic and asymptomatic group depending upon the clinical presentation.

Results:Among the 60 children, 43 (71.7%) patients had no identifiable risk factor for cholelithiasis. Predominant identifiable risk factor was ceftriaxone use in 7 (11.7%) patients. Forty four (73%) were nutrionally normal, fifty one (85%) patients were symptomatic and nine (9%) patients were asymptomatic. Anemia was noticed in 46 (76.7%) patients. Laparoscopic cholecystectomy was done for 29 (48.3%) patients, other surgical procedures in 7 (11.6%) patients and 23 (38.3%) patients were treated conservatively. Seven out of 9 patients in the asymptomatic group and 14 of symptomatic group treated conservative management had spontaneous resolution of cholelithiasis.

Conclusions:Gallstones need not be always present with symptoms and there is a significant number of children who were asymptomatic. Majority of the patients do not have identifiable risk factors. Most of the children were underweight. Laparoscopic cholecystectomy was advised for majority of symptomatic cholelithiasis.  


Cholelithiasis, Gallstone, Adolescents

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

Zubler J, Markowski G, Yale S, Graham R, Rosenthal TC. Natural history of asymptomatic gallstones in family practice office practices. Arch Fam Med. 1998;7:230-3.

Attili AF, De Santis A, Capri R, Repice AM, Maselli S. The natural history of gallstones. The GREPCO experience. The GREPCO Group. Hepatology. 1995;21:655-60.

Friedman GD, Raviola CA, Fireman B. Prognosis of gallstones with mild or no symptoms: 25 years of follow up in a health maintenance organization. J Clin Epidemiol. 1989;42:127-36.

McSherry CK, Ferstenberg H, Calhoun WF, Lahman E, Virshup M. The natural history of gallstone disease in symptomatic and asymptomatic patients. Ann Surg. 1985;202:59-63.

Wesdorp I, Bosman D, de Graaff A, Aronson D, van der Blij F, Taminiau J. Clinical presentations and predisposing factors of cholelithiasis and sludge in children. J Pediatr Gastroenterol Nutr. 2000;31:411-7.

Nomura H, Kashiwagi S, Hayashi J, Kajiyama W, Ikematsu H, Noguchi A, et al. Prevalence of gallstone disease in a general population of Okinawa, Japan. Am J Epidemiol. 1988;128:598- 605.

Oberoi SS. Updating income ranges for Kuppuswamy’s socio-economic status scale for the year 2014. Indian J Pub Health. 2015;59:156-7.

Rome Group for the Epidemiology and Prevention of Cholelithiasis (GREPCO). The Epidemiology of gallstone disease in Rome, Italy. Part I. Prevalence data in men. Hepatology. 1988;8:904-6.

Bainton D, Davies GT, Evans KT, Gravelle IH. Gallbladder disease. Prevalence in a South Wales Industrial Town. N Engl J Med. 1976;294:1147-9.

Khuroo MS, Mahajan R, Zargar SA, Javid G, Sapru S. Prevalence of biliary tract disease in India: a sonographic study in adult population in Kashmir. Gut. 1989;30:2001-5.

Singh V, Trikha B, Nain CK, Singh K, Bose SM. Epidemiology of gallstone disease in Chandigarh: a community-based study. J Gastroenterol Hepatol 2001;16:560-3.

Bogueu CO, Murphy AJ, Gerstle JT, Moineddin R, Daneman A. Risk factors, complications, and outcome of gallstones in children: a single center review. J Pediatr Gastroenterol Nutr. 2010;50:303-8.

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

Kumar K. To study the sensitivity and specificity of ultrasonography for diagnosing cholelithiasis in a tertiary care teaching hospital. Int J Med Res Prof. 2015;1(3);64-7.

Kaechele V, Wabitsch M, Thiere D, Kessler AL, Haenle MM, Mayer H, et al. Prevalence of gallbladder stone disease in obese children and adolescents: influence of the degree of obesity, sex and pubertal development. J Pediatr Gastroenterol Nutr. 2008;42:66-70.

Wesdorp I, Bosman D, de Graaff A, Aronson D, van der Blij F, Taminiau J. Clinical presentations and predisposing factors of cholelithiasis and sludge in children. J Pediatr Gastroenterol Nutr. 2000;31:411-7.

Koivusalo A, Pakarinen M, Gylling H, Nissinen MJ. Relation of cholesterol metabolism to pediatric gallstone disease: a retrospective controlled study. BMC Gastroenterol. 2015;15:74.

Della Corte C, Falchetti D, Nebbia G, Calacoci M, Pastore M, Francavilla R et al. Management of cholelithiasis in Italian children: a national multicenter study. World J Gastroenterol. 2008;14:1383-8.

Bruch SW, Ein SH, Rocchi C, Kim PCW. The management of nonpigmented gallstones inchildren. J Pediatr Surg. 2000;35:729-32.