Outcome of cholelithiasis in Sudanese children with Sickle Cell Anaemia (SCA) after 13 years follow-up

Abstract

Background: SCA causes chronic haemolysis which is a risk factor for cholelithiasis. Objective: To determine the prevalence and outcome of children with SCA complicated with gallstones treated at the sickle cell clinic at the children emergency hospital Khartoum state. Methods: 261 patients age 4 months to 16 years were studied. AUS examination was carried out. The 30 patients in whom gall stones were detected followed prospectively from June 1996 to September 2009 when a second AUS examination was obtained.Results: Gall stones occurred in 30 patients of whom four were lost to follow up in the first year. The overall prevalence of cholelithiasis was 11.5% and it increased with age. The youngest patient with cholelithiasis was 2 1/2 years old. Haematological variables, bilirubin and sex did not identify a subgroup of patients at higher risk for gallstones. All the patients were asymptomatic at the time of diagnosis. One patient developed symptoms 3years after the diagnosis and he was submitted to surgery. The 25 remaining asymptomatic patients were followed up for 13 years and none of them presented complications related to cholelithiasis during this period. Conclusion: The prevalence of cholelithiasis in Sudanese children and adolescents with SCA was significant. The large majority patients remained asymptomatic over a long period. African Health Sciences 2013; 13(1): 154 -159 http://dx.doi.org/10.4314/ahs.v13i1.21

Cholelithiasis in Children with Sickle Cell Disease in Ouagadougou Pediatric Hospital

“…Other authors as Silva in Greece and Itoua in Nigeria [10] [11] reported a prevalence greatly superior to ours, 40.9% and 31.30% respectively. However, many other African studies reported lower prevalence: 9.3% in Côte d'Ivoire, 9.4% in Senegal and 11.5% in Sudan [1] [2] [12]. Differences observed between prevalences could be related to patients' age in the series, their mode of selection or clinical signs.…”

“…Sickle cell disease is a genetic disease that causes anemia as well as acute and chronic tissue injuries in many organs [1]. Providing better care in our unit has increased the life expectancy of children with SCD [8].…”

“…Cholelithiasis is a frequent complication of chronic hemolysis due to sickle cell disease (SCD) [1]. It is sometimes revealed by digestive symptoms difficult to distinguish from painful abdominal vaso-occlusive crises (recurrent abdominal pain sometimes similar to biliary colic, nausea, vomiting).…”

“…However, cholelithiasis is often asymptomatic and can lead to serious complications (cholecystitis, cholangitis, pancreatitis, septicemia starting in the bile) which can jeopardize patients' lives [2] [3]. If excessive bilirubin excretion related to chronic hemolysis is a major risk factor for gallstones formation, other conducive factors which have not been identified yet could intervene [1] [4]. Many studies show that the prevalence of cholelithiasis in patients with sickle cell disease increases with age and affects 6% of patients before 15 years of age and more than 50% of young adults [1] [5] [6].…”

“…If excessive bilirubin excretion related to chronic hemolysis is a major risk factor for gallstones formation, other conducive factors which have not been identified yet could intervene [1] [4]. Many studies show that the prevalence of cholelithiasis in patients with sickle cell disease increases with age and affects 6% of patients before 15 years of age and more than 50% of young adults [1] [5] [6]. Gallstones treatment is equivocal but most of studies recommend cholecystectomy in the symptomatic cases and regular ultrasonography in the other cases [3] [7].…”