Adolescent gallstones—need for early intervention in symptomatic idiopathic gallstones

Sarrami, Mahsa; Ridley, William E; Nightingale, S. L.; Wright, Timothy; Kumar, Rajendra

doi:10.1007/s00383-019-04461-w

Cited by 28 publications

(24 citation statements)

References 28 publications

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“…Complications were documented in 20% of our cases, which is close to the literature, where they were reported in about 7-20% of cases [6]. While some older studies reported pancreatitis as the most common complication [15,16], recent studies reported cholecystitis and choledocholithiasis to be more common [1,11,17]. Our study showed choledocholithiasis to be more common; meanwhile, none of our cases showed pancreatitis or acute cholecystitis.…”

Section: Discussionsupporting

confidence: 86%

Gallstones in Egyptian infants and children: risk factors, complications and outcome: a single center experience

Enayet¹,

Afifi²,

Mogahed³

et al. 2020

Egypt Liver Journal

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Background: The widespread use of abdominal ultrasonography in children documented increased detection rate of gallstones. The aim of this study was to assess the possible risk factors of gallstones and to detect the complication rate and outcome of the disease in Egyptian infants and children from a hepatologist perspective. This prospective study included 35 cases, with ultrasound-detected gallstones, who presented to the Pediatric Hepatology Unit from July 2015 to October 2017. All patients were initially evaluated by full history, general and abdominal examination, laboratory assessment, and ultrasound findings to detect possible risk factors of gallstones. Management approach was individualized for each patient according to his/her condition, and the patients were followed up at 3 months interval. Results: The patients' ages ranged from 3.5 months up to 17 years. The median age of gallstone detection was 2 years. Gallstones were symptomatic in 62.9% with abdominal pain in 51.4%. Complications in the form of choledocholithiasis were detected in 7 patients (20%). Laparoscopic cholecystectomy was done for 7 patients while conservative management was applied for 24 patients. Complete resolution occurred in 8.3% and partial resolution in 33.3%. Chronic hemolytic anemia was the most commonly identified risk factor for gallstones. Patients needed surgical intervention had significant higher serum cholesterol and LDL levels (P = 0.006 and P = 0.002 respectively). Conclusion: Risk factors for gallstones could be identified in most of pediatric cases. Symptomatic presentation is common among the pediatric population. Conservative management is recommended for asymptomatic cases of gallstones in children. Laparoscopic cholecystectomy is a safe and recommended procedure for complicated and symptomatic cases of gallstones.

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Section: Discussionsupporting

confidence: 86%

Gallstones in Egyptian infants and children: risk factors, complications and outcome: a single center experience

Enayet¹,

Afifi²,

Mogahed³

et al. 2020

Egypt Liver Journal

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“…Prolonged obstruction results in inflammation, infection, and even ischemia, resulting in acute inflammation of GB; repeated episodes can result in chronic cholecystitis, in which a thickened GB wall, GB mucosal atrophy and scarring were detected (16). There is no consensus on the management of children with cholelithiasis and the risks of developing complications as a consequence of delaying surgery are well-known (17)(18)(19). More than 70% of cases admitted in emergency became symptomatic when surgery is delayed after a mean time of 38 months.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Cholecystectomy for Symptomatic Cholecystic Disease in Children: Defining Surgical Timing

et al. 2020

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Background: Laparoscopic cholecystectomy (LC) is the standard of care for gallbladder (GB) pathologies. We evaluated clinical, ultrasonographic (US) data as well as histopathological findings in children affected with symptomatic cholecystic disease (SCD) who underwent LC, with the aim of defining surgical timing. Methods: We reviewed our cases who underwent elective LC (ELC) or urgent LC (ULC). Clinical, US, surgical and histological features were used to create different risk scores. Results: We considered 26 children (17 ELC/9 ULC). US signs were not different in the two groups (p > 0.05). Operating times were longer in ELC than in ULC (p = 0.01). Histopathological evaluation revealed fibrosis and atrophy in both ELC and ULC. The clinical risk score was higher in ELC compared to ULC (p < 0.001). An increased operative risk score was noted in patients with systemic inflammatory signs (OR1.98), lithotherapy (OR1.4.3) and wall thickening ≥3 mm (OR2.6). An increased histopathological risk score was detected in children with symptom duration >7 days (OR3.61), concomitant hematological disease (OR1.23) and lithotherapy (OR3.61). Conclusion: Criteria adopted in adults cannot be adopted to detect the severity of GB damage in children. A dedicated clinical and US score is mandatory to define the most appropriate surgical timing.

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“…We found that female sex, hyperlipidemia, and primary AP with pancreatic necrosis were signi cantly correlated with ARP, and the severity of primary AP was positively correlated with ARP. The relationship between ARP and sex is controversial and perhaps related to the predominance of hyperlipidemia and biliary tract disease in women [27,28].…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics of acute pancreatitis in children: a single-center experience in Western China

Zhong

Tan

Yan

et al. 2020

Preprint

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Background: The diagnosis of pediatric pancreatitis has been increasing over the last 20 years. We aimed to compare the clinical characteristics for pediatric acute pancreatitis (AP) with adult AP, and investigate the risk factor for acute recurrent pancreatitis (ARP) in children. Method: From June 2013 to June 2019, a total of 130 pediatric patients with AP at the inpatient database were enrolled. Univariate analysis and multivariate Cox regression analysis were performed to identify the risk factors for ARP in children. Result: Major etiologic factors in 130 patients were biliary (31.5%), idiopathic (28.5%), trauma (16.2%). There was a significant difference in the constituent ratio of etiology between pediatric patients and adult patients (p<0.001). Compared with the adult patients, the pediatric patients had significantly lower severity (p=0.012) and occurrence rate of pancreatic necrosis (p=0.02). During the follow-up time (34.2±20.8 months), 19 children (14.6%) developed into ARP. Multivariate Cox regression analysis showed that female (p=0.025; OR=3.632; 95%confidence interval(CI) 1.179-11.188), hyperlipidemia (p=0.022; OR=3.480; 95%CI 1.201-10.085), pancreatic necrosis (p=0.001; OR=8.815; 95%CI 2.446-31.774) were the independent risk factors of ARP. The risk of recurrence was significantly different in each etiology group. Hyperlipidemic AP had the highest risk of recurrence over time, while viral and drug-induced AP had the lowest risk of recurrence (p=0.035).Conclusion: Biliary and idiopathic disease were the major etiologies of AP in children. Compared to adults, children tend to have milder disease conditions and a better prognosis. Female, hyperlipidemia, and first AP attack with pancreatic necrosis were associated with the increased risk of ARP.

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Adolescent gallstones—need for early intervention in symptomatic idiopathic gallstones

Cited by 28 publications

References 28 publications

Gallstones in Egyptian infants and children: risk factors, complications and outcome: a single center experience

Gallstones in Egyptian infants and children: risk factors, complications and outcome: a single center experience

Laparoscopic Cholecystectomy for Symptomatic Cholecystic Disease in Children: Defining Surgical Timing

Clinical characteristics of acute pancreatitis in children: a single-center experience in Western China

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