Cholecystitis and Cholelithiasis in Children

Abstract

At Kronprinsessan Lovisas Barnsjukhus during the period January 1950 to April 1961, 60 children with cholecystitis and/or cholelithiasis were operated upon. The series is larger than any series reported to date. The ages ranged from 6 to 15 years; there were 57 girls and three boys. The predominance of females to males is greater than that found in adults. Hemolytic anemia was an uncommon cause of cholelithiasis and occurred in three patients. Malformations of the gall-bladder were found in three cases. Body weight above the normal was a common finding in the series. No hereditary factor could be traced. Infection as a cause of cholecystitis was not found. Abdominal pain was the most common symptom. In many cases it was of an indefinite nature. The localization of the pain to the right costal margin was found on at least one occasion in 47 patients. Several patients, mostly in the younger age groups, localized the pain to the periumbilical region. Pain in connection with eating was seldom found. Jaundice was observed in three patients, apart from those having hemolytic anemias. The principal diagnostic acid was radiography. The diagnosis was fairly easily established in half of the cases. In some the symptoms persisted for up to 10 years before correct diagnosis was made. The abdominal pain had earlier led to operation for suspected appendicitis in 10 cases with the establishment of the correct diagnosis in one case. Cholecystography is recommended for children, particularly girls over 10 years of age, if the cause of the indefinite abdominal symptoms is elusive. The treatment was surgical in all cases. In 59 cases cholecystectomy was performed and in one case cholecystotomy. There were no deaths and no postoperative complications. Cholecystectomy is the operative procedure recommended in every case. In cholelithiasis there is a risk of a recurrence of calculi of cholecystotomy only is performed. There were no noteworthy disadvantages in removing the gall-bladder in a child. At the follow-up examination, three out of 59 cholecystectomized patients disclosed symptoms such as moderate biliary dyskinesia.