Cholelithiasis in children with sickle-cell anemia in Dakar - Senegal

Background. - Cholelithiasis is a well recognized complication of sickte-ce ll anemia (SCA) because of chronic hemolysis. It is usually asymptomatic bu t may result in acute cholecystitis of cholangitis. The aim of this study w as to assess prevalence of cholelithiasis ann its associated factors among Senegalese children and adolescents with SCR. Patients and methods. - We analyzed the follow-up records and results of sy stematic clinical biological and ultrasonographic examinations in 106 patie nts with SCA aged 11 months to 22 years (median: 10 years, 6 months), follo wed up in the Albert- Rover Children's Hospital (Dakar). Results. - Cholelithiasis was detected in 9.4% of the patients. Gentler; et hnic group. geographic origin and socioeconomic conditions did plot have an y association with cholethiasis frequency The frequency. The youngest patie nt with cholelithiasis was 7 years old and prevalence of cholelithiasis inc reased with age. The mean age at the beginning of SCA follow-up was higher among patients with cholelithiasis. They were more frequently transfused an d tended to present more frequent pain crises and other complications of SC A. We found no spontaneous clinical manifestations attributed to cholelithi asis. Nevertheless. provoked right upper quadrant pain was more frequently observed in patients with cholelithiasis. Fetal hemoglobin, steady-state he moglobin, reticulocytes count, serum bilirubin, alkaline phostatase and tra nsaminase levels were not significantly different in these patients, compar ed to the others. However, those with cholelithiasis had significantly high er mean red cell volume. Conclusion. - Prevalence or cholelithiasis appears relatively low in Senega lese patients with SCA, probably owing to the tolerance of the Senegal hapl otype. Advanced age and severe chronic hemolysis are etiologic factors in e vidence. We recommend systematic abdominal ultrasound at least once a year for patients older than 5 years, or when right upper quadrant pain is obser ved. Cholecystectomy should be performed in cases of cholelithiasis in orde r to prevent complications. (C) 1999 Editions scientifiques et medicale Els evier SAS.