title: Adenomyomatosis of the gallbladder in childhood: A systematic review of the literature and an additional case report.
abstract: OBJECTIVE
  To investigate the diagnostic and therapeutic assessment in children with adenomyomatosis of the gallbladder (AMG).
  
  
  METHODS
  AMG is a degenerative disease characterized by a proliferation of the mucosal epithelium which deeply invaginates and extends into the thickened muscular layer of the gallbladder, causing intramural diverticula. Although AMG is found in up to 5% of cholecystectomy specimens in adult populations, this condition in childhood is extremely uncommon. Authors provide a detailed systematic review of the pediatric literature according to PRISMA guidelines, focusing on diagnostic and therapeutic assessment. An additional case of AMG is also presented.
  
  
  RESULTS
  Five studies were finally enclosed, encompassing 5 children with AMG. Analysis was extended to our additional 11-year-old patient, who presented diffuse AMG and pancreatic acinar metaplasia of the gallbladder mucosa and was successfully managed with laparoscopic cholecystectomy. Mean age at presentation was 7.2 years. Unspecific abdominal pain was the commonest symptom. Abdominal ultrasound was performed on all patients, with a diagnostic accuracy of 100%. Five patients underwent cholecystectomy, and at follow-up were asymptomatic. In the remaining patient, completely asymptomatic at diagnosis, a conservative approach with monthly monitoring via ultrasonography was undertaken.
  
  
  CONCLUSIONS
  Considering the remote but possible degeneration leading to cancer and the feasibility of laparoscopic cholecystectomy even in small children, evidence suggests that elective laparoscopic cholecystectomy represent the treatment of choice. Pre-operative evaluation of the extrahepatic biliary tree anatomy with cholangio-MRI is strongly recommended.
authors.affiliation: Filippo Parolini, Miguel Garcia Magne, Giovanni Boroni, Daniele Alberti, Department of Paediatric Surgery, "Spedali Civili" Children's Hospital, 25123 Brescia, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Parolini
authors.affiliation: Filippo Parolini, Miguel Garcia Magne, Giovanni Boroni, Daniele Alberti, Department of Paediatric Surgery, "Spedali Civili" Children's Hospital, 25123 Brescia, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Indolfi
authors.affiliation: Filippo Parolini, Miguel Garcia Magne, Giovanni Boroni, Daniele Alberti, Department of Paediatric Surgery, "Spedali Civili" Children's Hospital, 25123 Brescia, Italy.
authors.forename: Miguel Garcia
authors.initials: MG
authors.lastname: Magne
authors.affiliation: Filippo Parolini, Miguel Garcia Magne, Giovanni Boroni, Daniele Alberti, Department of Paediatric Surgery, "Spedali Civili" Children's Hospital, 25123 Brescia, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Salemme
authors.affiliation: Filippo Parolini, Miguel Garcia Magne, Giovanni Boroni, Daniele Alberti, Department of Paediatric Surgery, "Spedali Civili" Children's Hospital, 25123 Brescia, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cheli
authors.affiliation: Filippo Parolini, Miguel Garcia Magne, Giovanni Boroni, Daniele Alberti, Department of Paediatric Surgery, "Spedali Civili" Children's Hospital, 25123 Brescia, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Boroni
authors.affiliation: Filippo Parolini, Miguel Garcia Magne, Giovanni Boroni, Daniele Alberti, Department of Paediatric Surgery, "Spedali Civili" Children's Hospital, 25123 Brescia, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Alberti
keywords: Adenomyomatosis; Children; Gallbladder; Laparoscopy; Ultrasound