Cholelithiasis in childhood: Report of two cases from Afghanistan and literature review

Introduction

Cholelithiasis is a rare abdominal condition in children. The cause of pediatric cholelithiasis is unclear, and the most commonly occurring type is pigment stones due to hemolytic diseases and other causes such as medications, hepatobiliary tract anomalies, and genetic problems. Asymptomatic patients require monitoring, whereas symptomatic patients require surgical removal of the gall bladder (cholecystectomy), which can be performed using open or laparoscopic techniques. Here, we present two cases of cholelithiasis (symptomatic and asymptomatic) with neglect of proper medical management until a definite diagnosis and surgical treatment.

Case presentation

A 13-year-old and an 11-year-old child were presented with the diagnosis of cholelithiasis to our pediatric surgery department. The earlier patient suffered from jaundice in early childhood and was treated with the traditional method (non-surgical home remedy using an onion). Later, he was diagnosed with multiple gallbladder stones. The later patient was asymptomatic until his hospitalization at the age of 11 years, when he was diagnosed with a single gallbladder stone (epigastric pain after heavy meals as a chief complaint). Both patients were symptomatic, so we decided to plan them for definite treatment. The patients underwent cholecystectomy with no complications and were discharged from the hospital in satisfactory condition.

Clinical discussion

However, cholelithiasis is uncommon in children, but recent reports indicate increased detection of the disease. In developed nations, an increase in childhood obesity has risen the rate of gallstone cases in the pediatric population. Typically, pediatric cholelithiasis is asymptomatic, but symptomatic children may present with biliary colic as the sudden onset of recurrent epigastric or right upper quadrant (RUQ) pain radiating to the back or right shoulder. In young children, the episodes are accompanied by nausea, vomiting, and fever. Many times, the pain develops without precipitating factors, and fat intolerance is an inconsistent feature. The management of cholelithiasis requires a concise work-up regarding its cause in children.

Conclusion

Cholelithiasis has different underlying causative factors. In otherwise healthy children, surgical treatment is only warranted in symptomatic cases.