Gallstones and common bile duct calculi in infancy and childhood

Background: Gallstones and common bile duct calculi have been increasingly diagnosed in recent years in infants and children. The present study aims t o review the spectrum of this disorder in the last two decades. Methods: During the period 1979-96 a total of 102 consecutive infants and c hildren were diagnosed in Royal Alexandra Hospital for Children with gallst ones or common bile duct calculi. A detailed retrospective analysis and fol low-up of these children form the basis of the present report. Results: The median age at presentation was 10 years. Recurrent right upper quadrant pain was the most common clinical presentation. The male-to-femal e ratio was 3:2 and this male predominance was noted in all the age groups. Aetiologically three identifiable groupings were noted: idiopathic disease (n = 66), haematological diseases (n = 23) and specific non-haematological disease (n = 13). The incidence of idiopathic and haematological stones ha d increased two-fold in the second half of the study. The majority of child ren (86%) underwent surgical correction. Choledocholithiasis (CDL) was note d in 18 children (18%). Jaundice was commonly associated with abdominal pai n in this group. A higher incidence of common bile duct calculi was noted i n females and children less than 5 years of age (P < 0.01). Common bile duc t calculi were accurately diagnosed by pre-operative imaging in all 18 chil dren. Surgical correction was required in all except two. Conclusions: The present study suggests an increasing incidence of gallston es in children. Cholelithiasis in children occurs commonly in boys, is idio pathic in aetiology and presents with a vague right upper quadrant pain. Ch oledocholithiasis is not uncommon in children, occurs more commonly in girl s aged < 5 years and presents with jaundice or abnormal liver function test s.