Cholelithiasis in sickle cell children: experience of a French pediatric hospital

Background. - Gallstones are frequently encountered in sickle cell disease. Their complications are difficult to distinguish from vaso-occlusive abdom inal pain and they can sometimes threaten the patient's life. The aim of th is study was to describe our local experience with cholelithiasis in childr en with sickle cell disease. Patients and methods. - We analyzed the follow-up records and abdominal son ography results of 185 children with sickle cell anemia, aged zero to 18 ye ars, followed up in Trousseau Children's Hospital (Paris) from 1982 to 1998 . Results. - Cholelithiasis was detected in 26 patients. The youngest patient was five years old. Cholelithiasis was discovered because of clinical mani festations in 12 patients. Asymptomatic cholelithiasis patients developed c linical manifestations in 28% cases in a maximum delay of two and a half ye ars after its diagnosis. Laparoscopic cholecystectomy was performed in nine cases and open cholecystectomy in 17 cases. The mean postoperative length of stay was significantly shorter in the group of patients with laparoscopy in comparison with the group with open cholecystectomy. Histologic analysi s of the gallbladders noted 85 % of acute or chronic cholecystis. Conclusion. - We suggest that cholelithiasis should be carefully sought in the presence of abdominal manifestations in sickle cell patients. We recomm end that annual abdominal sonography be performed in sickle cell patients a s early as seven years of age and elective cholecystectomy be performed on patients with cholelithiasis. (C) 2001 Editions scientifiques et medicales Elsevier SAS.