Risk factors, complications, and outcomes of gallstones in children: a single-center review.
OBJECTIVE
The increasing use of sonography has resulted in an increase in the proportion of children with gallstones who are asymptomatic at the time of diagnosis. In adults, the literature supports expectant management of clinically silent gallstones. The evidence for this management approach in children is limited to a number of small series. Our objective was to review the risk factors, complications, and outcomes of gallstones at our institution, particularly in those patients who are asymptomatic at the time of initial diagnosis.


METHODS
We reviewed 382 cases of gallstones in children. These patients were diagnosed with sonography. Data on age at diagnosis, presentation, sonographic findings, risk factors, complications, surgery, and follow-up were collected. A chi2 test was used to compare the complication rates between symptomatic and asymptomatic groups. Descriptive statistics were used to analyze the sample.


RESULTS
At diagnosis, 50.5% of children were asymptomatic; these patients were diagnosed at a mean age of 8.23 years. Compared with symptomatic patients, they were less likely to have a hemolytic anemia but more likely to have other risk factors, including cardiac surgery, leukemia and lymphoma, short bowel syndrome, or exposure to total parenteral nutrition or cephalosporins. These patients had a lower rate of complications than the symptomatic patients (4.6% vs 28.2% of symptomatic, P < 0.0001) and only 3.1% developed symptoms that necessitated surgery (vs 59.0% of symptomatic). Of the 58 (15.1%) diagnosed in infancy, 47 (81.0%) were asymptomatic. The infant group also had low rates of complications (8.6%) and cholecystectomy (1.7%). In cases with sonographic follow-up, resolution of gallstones was demonstrated in 16.5% of asymptomatic patients and in 34.1% of infants.


CONCLUSIONS
The data suggest that clinically silent gallstones in children and infants are associated with low rates of complications and can be managed conservatively, unless complications occur. Patients with sickle cell disease, spherocytosis, and elliptocytosis had high complication rates and required surgery more often.
Bogue
Conor O
CO
Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada. cbogue@eircom.net
Murphy
Amanda J
AJ
Gerstle
J Ted
JT
Moineddin
Rahim
R
Daneman
Alan
A
D000293:Adolescent; D017677:Age Distribution; D000743:Anemia, Hemolytic / Q000150:complications; D002511:Cephalosporins / Q000009:adverse effects / Q000627:therapeutic use; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D002763:Cholecystectomy; D002769:Cholelithiasis / Q000150:complications* / Q000628:therapy; D005260:Female; D042882:Gallstones / Q000150:complications* / Q000628:therapy; D006331:Heart Diseases / Q000150:complications; D006801:Humans; D007223:Infant; D007938:Leukemia / Q000150:complications; D008223:Lymphoma / Q000150:complications; D008297:Male; D010288:Parenteral Nutrition / Q000009:adverse effects; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012778:Short Bowel Syndrome / Q000150:complications; D016896:Treatment Outcome
D002511:Cephalosporins