Cholelithiasis in children with sickle cell disease

Al-Salem, Ahmed H.; Qaisaruddin, Syed; Al-Dabbous, Ibrahim A.; Bhamidipati, Pavan Kumar; Srair, Hussain Abu; Amman, H.; Jam'a, Ali Al

doi:10.1007/bf00180085

Cited by 31 publications

(26 citation statements)

References 16 publications

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“…In the Eastern Province of Saudi Arabia, an overall 19.7% frequency of cholelithiasis was reported in children with SCD. This frequency however, increased to 36% in those 15-18 years of age [5]. A 30% incidence of common bile duct stones was also reported in children with SCD undergoing cholecystectomy [18].…”

Section: Discussionmentioning

confidence: 76%

“…The recent liberal use of ultrasound for the investigation of children with abdominal complaints resulted in an increase detection of biliary and pancreatic diseases. This is more so in areas like the Eastern Province of Saudi Arabia where hemoglobinopathies are common with increased frequency of cholelithiasis and choledocholithiasis [5]. As a result of this, ERCP is being used with increased frequency for the investigation as well as treatment of biliary and pancreatic diseases in children [6][7][8].…”

Section: Introductionmentioning

confidence: 98%

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Diagnostic and therapeutic ERCP in the pediatric age group

2006

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The role and value of endoscopic retrograde cholangiopancreatography (ERCP) in the pediatric age group is not well established, because pancreatic and biliary diseases are less common in children. This however is not the case in areas like the Eastern Province of Saudi Arabia where sickle cell disease (SCD) and other hemoglobinopathies are common, with increased frequency of cholelithiasis and choledocholithiasis. The purpose of this study was to evaluate the indications, findings, safety and therapies of ERCP in children. One hundred and twenty five children had diagnostic and/or therapeutic ERCP as part of their management at our hospital. Their medical records were reviewed for: age at diagnosis, sex, Hb electrophoresis, indication for ERCP, findings, therapy and complications. There were 77 males and 48 females. Their age at presentation ranged from 5-18 year (mean 13.25 year). The majority of them had sickle cell disease (77.6%). The indications for ERCP were: obstructive jaundice (67.2%), recurrent biliary colic with or without jaundice (10.4%), acute and chronic pancreatitis (7.2%), postoperative bile leak (2.4%), cholangitis with obstructive jaundice (2.4%), hepatitis of unknown etiology (3.2%), cirrhosis of unknown etiology (4%), thalassemia with jaundice (0.8%), hemobilia (0.8%), acute cholecystitis with jaundice (0.8%), and sickle cell disease with ulcerative colitis and obstructive jaundice (0.8%). In six children, ERCP was done following laparoscopic cholecystectomy. ERCP was carried out under sedation in 91 (72.8%) children and under general anesthesia in 34. It was successful in 121 (96.8%) children while cannulation of the Ampulla failed in four. ERCP was normal in 43 children, but eight of them showed evidence of recent stone passage and in six, there were gallstones. In the remaining children, ERCP revealed: normal CBD with stones (18 patients), dilated CBD with stones (17 patients), dilated CBD without stones (19 patients), dilated biliary tree with stones (10 patients), dilated biliary tree without stones (six patients), bile leak (two patients), dilated biliary tree with stones and choledocho-duodenal fistula (one patient), choledochal cyst (two patients), septate gallbladder (one patient), normal ERCP with multiple pancreatic cysts (one patient) and biliary stricture (one patient). The following procedures were carried out: 35 had endoscopic sphincterotomy and stone extraction, 20 had endoscopic sphincterotomy, four had CBD stenting, one underwent removal of a stent, two had insertion of a nasobiliary tube and one had biliary endoprosethesis. There was no mortality. One had bleeding from the site of sphincterotomy which stopped after adrenaline injection. Four patients (3.2%) developed transient mild pancreatitis which settled conservatively. ERCP in the pediatric age group is safe both as a diagnostic and therapeutic procedure. ERCP can provide valuable information which aid in the diagnosis of biliary and pancreatic diseases in children as well as therapy with the technical feasibility of ...

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Section: Discussionmentioning

confidence: 76%

Section: Introductionmentioning

confidence: 98%

Diagnostic and therapeutic ERCP in the pediatric age group

2006

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“…Sferositoz, eliptositoz ve stomatositoz gibi temelde hemolitik bir bozukluğu olan çocuklarda ve talasemi (α ve β), hemoglobin C ve orak hücreli anemide safra taşları sık görülür. Orak hücreli anemide 20 yılda safra taşı oluşum insidansının %50'ye kadar çıktığı bildirilmiştir (11,12) . Bu nedenle orak hüc-reli anemi tanısı alan hastalarda elektif kolesistektomi yapılması önerilmektedir (13) .…”

Section: Discussionunclassified

Laparoscopic Cholecystectomy In Childhood

Mert¹,

Özdemir²,

Sayan³

et al. 2017

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“…4 In children with non-hemolytic gallstones, a frequency of about 7% of choledocholithiasis has been reported. 2 This is in comparison with 14% to 30% in SCD patients with gallstones.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, however, and as a result of the routine use of ultrasonography in the evaluation of children with abdominal pain, biliary and pancreatic diseases are being diagnosed more often in children, 2 especially in areas where hemolytic diseases which are known to be associated with increased frequency of cholelithiasis and choledocholithiasis are common. [3][4][5] The present study describes our experience with ERCP in the evaluation, diagnosis and treatment of pancreatobiliary disorders in children and demonstrates its value in the era of laparoscopic cholecystectomy.…”

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confidence: 88%

The Role of ERCP in the Evaluation, Diagnosis and Therapy of Biliary and Pancreatic Diseases in Children

1999

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The role of endoscopic retrograde cholangiopancreatography (ERCP) for the investigation and treatment of biliary and pancreatic diseases is well established in adults.1 This, however, is not the case in the pediatric age group, because biliary and pancreatic diseases are less common in children. In addition to this problem is the lack of pediatric gastroenterologists who are skilled in performing ERCP in children. Recently, however, and as a result of the routine use of ultrasonography in the evaluation of children with abdominal pain, biliary and pancreatic diseases are being diagnosed more often in children, 2 especially in areas where hemolytic diseases which are known to be associated with increased frequency of cholelithiasis and choledocholithiasis are common. 3-5The present study describes our experience with ERCP in the evaluation, diagnosis and treatment of pancreatobiliary disorders in children and demonstrates its value in the era of laparoscopic cholecystectomy. Patients and MethodsOver a four-year period from September 1993 to August 1997, 34 consecutive children less than 18 years old had ERCP as part of their management at our hospital. The records of these patients were reviewed retrospectively for age, gender, indication for ERCP, pre-ERCP investigations, results, complications of ERCP and post-ERCP management.Informed, written consent for ERCP was obtained from the child's parent. All ERCPs were performed in the Radiology Department. For patients 10 years old and below, ERCP was performed under general anesthesia with nasotracheal intubation. In those older than 10 years, ERCP was done under sedation only. Patients with sickle cell disease were hydrated with intravenous fluids starting the night before the procedure, at a rate of 1½ their maintenance requirements, and blood transfusions were given when necessary to increase their Hb to 10-12 g/dL. With the patients properly sedated, using meperedine (1 mg/kg) and diazepam (0.1-0.2 mg/kg), the Olympus JF1 T20 side-viewing duodenoscope was used in all the patients. After visualization, the ampulla of Vater was cannulated with tapered catheters and the pancreatic and biliary ducts were visualized by fluoroscopy during injection of Hexabrix (320 mg was diluted to 50%). Appropriate radiographs were obtained in all cases. Where indicated, sphincterotomy was performed using 5F sphincterotome (Olympus). Common bile duct stone extraction was performed with basket and balloon catheters. During the procedure, all patients were monitored with pulse oximetry with a cardiorespiratory trolley at the bedside. ResultsThe 34 children who had ERCP at Qatif Central Hospital as part of their management over the four-year study period comprised 20 males and 14 females. Their ages ranged from 5-18 years (mean 14.5 years). Of the 34 patients, 29 (85.3%) had sickle cell disease (SCD). Their mean HbS level was 77.8% (range 66.1-90.7) and their mean HbF level was 21% (range 7.2-37). The indications for ERCP are shown in Table 1. Obstructive jaundice was the most common i...

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Cholelithiasis in children with sickle cell disease

Cited by 31 publications

References 16 publications

Diagnostic and therapeutic ERCP in the pediatric age group

Diagnostic and therapeutic ERCP in the pediatric age group

Laparoscopic Cholecystectomy In Childhood

The Role of ERCP in the Evaluation, Diagnosis and Therapy of Biliary and Pancreatic Diseases in Children

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