Risk factors, complications, and outcomes of gallstones in children: a single-center review.

Backgroun d and Objective: The increasing use of sonography has resulted in an increase in the proportion of children with gallstones who are asymptoma tic at the time of diagnosis. In adults, the literature supports expectant manageme nt of clinically silent gallstones. The evidence for this manageme nt approach in children is limited to a number of small series. Our objective was to review the risk factors, complication s, and outcomes of gallstones at our institution, particularly in those patients who are asymptomatic at the time of initial diagnosis. Materials and Methods: We reviewed 382 cases of gallstones in children. These patients were diagnosed with sonography . Data on age at diagnosis, presentation, sonogra phic findings, risk factors, complication s, surgery, and follow-up were collected. A x 2 test was used to compare the complication rates between symptoma tic and asymptomati c groups. Descriptiv e statistics were used to analyze the sample. Results: At diagnosis, 50.5% of children were asymptomatic ; these patients were diagnosed at a mean age of 8.23 years. Compared with symptoma tic patients, they were less likely to have a hemolytic anemia but more likely to have other risk factors, including cardiac surgery, leukemia and lymphoma, short bowel syndrome , or exposure to total parenteral nutrition or cephalospo rins. These patients had a lower rate of complication s than the symptomati c patients (4.6% vs 28.2% of symptomatic , P < 0.0001) and only 3.1% developed symptoms that necessitate d surgery (vs 59.0% of symptomati c). Of the 58 (15.1%) diagnosed in infancy, 47 (81.0%) were asymptoma tic. The infant group also had low rates of complication s (8.6%) and cholecyste ctomy (1.7%). In cases with sonographic follow-up, resolution of gallstones was demonstrated in 16.5% of asymptom atic patients and in 34.1% of infants. Conclusio ns: The data suggest that clinically silent gallstones in children and infants are associated with low rates of complication s and can be managed conservat ively, unless complication s occur. Patients with sickle cell disease, spherocytos is, and elliptocytosis had high complica tion rates and required surgery more often.