The increasing use of sonography has resulted in an increase in the proportion of children with gallstones who are asymptomatic at the time of diagnosis.
In adults, the literature supports expectant management of clinically silent gallstones.
The evidence for this management approach in children is limited to a number of small series.
Dr Conor Bogue and colleagues reviewed the risk factors, complications, and outcomes of gallstones at our institution, particularly in those patients who are asymptomatic at the time of initial diagnosis.
The research team reviewed 382 cases of gallstones in children.
|3% developed symptoms that necessitated surgery|
|Journal of Pediatric Gastroenterology & Nutrition|
These patients were diagnosed with sonography.
Data on age at diagnosis, presentation, sonographic findings, risk factors, complications, surgery, and follow-up were collected.
At diagnosis, 51% of children were asymptomatic, and these patients were diagnosed at a mean age of 8 years.
Compared with symptomatic 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 cephalosporins.
The research team found that these patients had a lower rate of complications than the symptomatic patients, and only 3% developed symptoms that necessitated surgery.
Of the 58 diagnosed in infancy, 47 were asymptomatic.
The team noted that the infant group also had low rates of complications and cholecystectomy.
In cases with sonographic follow-up, resolution of gallstones was demonstrated in 17% of asymptomatic patients and in 34% of infants.
Dr Bogue's team concludes, "The data suggest that clinically silent gallstones in children and infants are associated with low rates of complications, and can be managed conservatively, unless complications occur."
"Patients with sickle cell disease, spherocytosis, and elliptocytosis had high complication rates and required surgery more often."