[Childhood cholelithiasis. Analysis of 24 patients diagnosed in our department and review of 123 cases published in Spain].

INTRODUCTION

Childhood cholelithiasis is being increasingly diagnosed worldwide, particularly in Spain. We retrospectively analyzed several epidemiological, clinical, diagnostic, etiologic and therapeutic aspects of this disease in 123 pediatric cases reported in Spain since 1971.

PATIENTS AND METHODS

Twenty four patients with cholelithiasis were diagnosed in our department between 1981 and 1999. Data on sex, age at diagnosis, form of clinical presentation, imaging studies used in diagnosis, etiology and underlying associated diseases, complications and treatment were retrospectively analyzed. The data obtained on the patients in our study were compared with and added to those of a further 99 pediatric cases published in Spanish medical journals since 1971. Cases diagnosed during the neonatal period were not included.

RESULTS AND CONCLUSIONS

The main findings were the following. The mean age at diagnosis was 7.8 years. The percentage of males was 51% and that of females was 49%. A total of 33.3% of the patients were asymptomatic and 66.6% were symptomatic. The most frequent symptoms were abdominal pain with or without vomiting (94%), jaundice (13.4%) and fever (9.7%). Etiology was idiopathic in 60.2% of patients and secondary in 39.8%. In the latter group the main causes of cholelithiasis were hemolytic anemia in 19 patients, obesity in 12, biliary tract malformations, hypercholesterolemia and liver disease in 4, and cystic fibrosis in 3. Diagnosis was based on abdominal ultrasonography in 89.4% of the patients and on Xray in 60.1%. Complications found were cholecystitis in five patients and pancreatitis in seven. One child with pancreatitis died from acute respiratory distress syndrome. Surgical treatment was given to 55.3% of the patients while 43.9% were treated conservatively. In one child cholelithotripsy was used.