The management of nonpigmented gallstones in children

Background/Purpose: An increasing number of children are diagnosed with gal lstones today. The best management of nonpigmented gallstones in children w ithout hematologic disorders is not known. Methods: The authors prospectively studied 74 children with cholelithiasis diagnosed with ultrasonography. Clinical presentation, natural history, com plications, and indications for cholecystectomy were examined. The follow-u p (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 fol lowed. The average age was similar in the 2 groups (11.7 v 11.0 years). Chi ldren with risk factors for cholelithiasis required earlier surgical treatm ent (P < .001). In the operative group, 8 presented acutely and 25 elective ly. There were 2 complications, a wound infection and a retained common duc t stone. In the group that underwent follow-up, 34 of 41 children remained asymptomatic or had symptoms improve with dietary manipulation. No complica tions developed during the follow-up period. Conclusions: Children with gallstones and typical symptoms of right upper q uadrant or epigastric pain with food intolerance should undergo cholecystec tomy. Eighty-two percent of children with cholelithiasis and atypical sympt oms had improvement with dietary manipulation. Pediatric patients with gall stones that are asymptomatic or associated with atypical symptoms can be sa fely followed without complications. Copyright (C) 2000 by W.B. Saunders Co mpany.