Calcium carbonate gallstones in children.
BACKGROUND
In the United States, cholesterol stones account for 70% to 95% of adult gallstones and black pigment stones for most of the remainder. Calcium carbonate stones are exceptionally rare. A previous analysis of a small number of pediatric gallstones from the north of England showed a remarkably high prevalence of calcium carbonate stones. The aims of this study were to analyze a much larger series of pediatric gallstones from our region and to compare their chemical composition with a series of adult gallstones from the same geographic area.


METHODS
A consecutive series of gallbladder stones from 63 children and 50 adults from the north of England were analyzed in detail using Fourier transform infrared microspectroscopy. Demographic and clinical data were collected on all patients. The relative proportions of each major stone component were assessed: cholesterol, protein and calcium salts of bilirubin, fatty acids, calcium carbonate, and hydroxyapatite.


RESULTS
Thirty-nine (78%) adults had typical cholesterol stones, 7 (14%) had black pigment bilirubinate stones, and only 2 (4%) had calcium carbonate stones. In contrast, 30 (48%) children had black pigment stones, 13 (21%) had cholesterol stones, 15 (24%) had calcium carbonate stones, 3 (5%) had protein dominant stones, and 2 (3%) had brown pigment stones. In children, cholesterol stones were more likely in overweight adolescent girls with a family history of gallstones, whereas black pigment stones were equally common in boys and girls and associated with hemolysis, parenteral nutrition, and neonatal abdominal surgery. Calcium carbonate stones were more common in boys, and almost half had undergone neonatal abdominal surgery and/or required neonatal intensive care.


CONCLUSIONS
The composition of pediatric gallstones differs significantly from that found in adults. In particular, one quarter of the children in this series had calcium carbonate stones, previously considered rare. Geographic differences are not the major reason for the high prevalence of calcium carbonate gallstones in children.
Stringer
Mark D
MD
Children's Liver Unit, St James's University Hospital, Leeds LS9 7TF, UK. mark.stringer@anatomy.otago.ac.nz
Soloway
Roger D
RD
Taylor
Donald R
DR
Riyad
Kallingal
K
Toogood
Giles
G
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001663:Bilirubin / Q000032:analysis; D002119:Calcium Carbonate / Q000032:analysis*; D002648:Child; D002675:Child, Preschool; D002769:Cholelithiasis / Q000737:chemistry* / Q000453:epidemiology; D001651:Cholestasis, Extrahepatic / Q000150:complications; D002784:Cholesterol / Q000032:analysis; D015897:Comorbidity; D003549:Cystic Duct; D004739:England / Q000453:epidemiology; D005227:Fatty Acids / Q000032:analysis; D005260:Female; D006461:Hemolysis; D006801:Humans; D008297:Male; D050177:Overweight; D010288:Parenteral Nutrition / Q000009:adverse effects; D011506:Proteins / Q000032:analysis; D012307:Risk Factors; D017550:Spectroscopy, Fourier Transform Infrared
D005227:Fatty Acids; D011506:Proteins; D002784:Cholesterol; D002119:Calcium Carbonate; D001663:Bilirubin