title: The management of nonpigmented gallstones in children.
abstract: OBJECTIVE
  An increasing number of children are diagnosed with gallstones today. The best management of nonpigmented gallstones in children without hematologic disorders is not known.
  
  
  METHODS
  The authors prospectively studied 74 children with cholelithiasis diagnosed with ultrasonography. Clinical presentation, natural history, complications, and indications for cholecystectomy were examined. The follow-up (mean, 21 months) consisted of routine clinic visits, chart reviews, and telephone questionnaires with the children or their parents.
  
  
  RESULTS
  Of the 74 children, 33 required cholecystectomies, and 41 were followed. The average age was similar in the 2 groups (11.7 v 11.0 years). Children with risk factors for cholelithiasis required earlier surgical treatment (P < .001). In the operative group, 8 presented acutely and 25 electively. There were 2 complications, a wound infection and a retained common duct stone. In the group that underwent follow-up, 34 of 41 children remained asymptomatic or had symptoms improve with dietary manipulation. No complications developed during the follow-up period.
  
  
  CONCLUSIONS
  Children with gallstones and typical symptoms of right upper quadrant or epigastric pain with food intolerance should undergo cholecystectomy. Eighty-two percent of children with cholelithiasis and atypical symptoms had improvement with dietary manipulation. Pediatric patients with gallstones that are asymptomatic or associated with atypical symptoms can be safely followed without complications.
authors.affiliation: University of Toronto, The Hospital for Sick Children, Ontario, Canada.
authors.forename: S W
authors.initials: SW
authors.lastname: Bruch
authors.forename: S H
authors.initials: SH
authors.lastname: Ein
authors.forename: C
authors.initials: C
authors.lastname: Rocchi
authors.forename: P C
authors.initials: PC
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D002137:Calculi / Q000737:chemistry*; D002648:Child; D002675:Child, Preschool; D002769:Cholelithiasis / Q000000981:diagnostic imaging / Q000178:diet therapy* / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011336:Probability; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014463:Ultrasonography