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PubMed1992

Cholelithiasis in newborns and infants.

Cholelithiasis in infants is rare, and has usually been associated with hemolysis, ileal disease, congenital anomalies of the biliary tree, hyperalimentation, and prolonged fasting. With the increased use of abdominal ultrasonography (US), more cases of cholelithiasis are being discovered. We report our experience with 13 infants diagnosed on abdominal US to have gallstones. There were 9 boys and 4 girls with an average age at diagnosis of 2.6 months (range, 0 to 9 months). Predisposing factors could be identified in only 6 of the 13 patients. Two patients with obstructive jaundice underwent cholecystectomy and common bile duct exploration. One patient with choledocolithiasis and common bile duct dilatation was observed. His stone passed spontaneously, with resolution of symptoms. Ten patients without cholestasis remained asymptomatic, with disappearance of lithiasis in five of them. Neonatal cholelithiasis is more common than previously suspected; it seems to affect males more often than females and is usually not associated with known predisposing factors. It appears to be a temporary, self-limiting phenomenon, and an aggressive approach is not warranted in the asymptomatic infant. Surgical or radiological intervention should be reserved for the symptomatic patients or those with underlying lithogenic disorders.

Cholecystectomy↗
PubMed1995

Cholelithiasis in pediatric cardiac transplant patients on cyclosporine.

From June 1984 to June 1993, symptomatic chlolethiasis was observed in six (6.7%) of 90 cases of pediatric heart or heart-lung transplants at the author's institution. The incidence of cholelithiasis for all children under 16 years of age is estimated to be less than 1%. Previously, information on cholelithiasis in pediatric transplant patients on cyclosporine therapy had been limited. Studies concerning the incidence of gallstones in adult kidney and cardiac transplant patients have shown that there is an increase associated with cyclosporine, possibly related to elevated levels and hepatoxicity. Five patients underwent uneventful cholecystectomy. There was only one death, which occurred after emergency cholecysostomy tube placement for biliary sepsis. If indicated, biliary tract surgery can be performed safely in cardiac transplant patients. The authors report on their experience with symptomatic cholelithiasis in pediatric cardiac transplant patients and review the current literature on the hepatotoxic effects of cyclosporine.

Adolescent↗
PubMedDate not supplied

Surgery in the elderly: observations on the pathophysiology and treatment of cholelithiasis.

Biliary tract disease is particularly prevalent in older persons, and is the leading indication for acute abdominal surgery in the elderly. The complications of biliary stone disease are more insidious in the elderly, and the recognition of "symptomatic" disease is often delayed. The unreliable manifestations of biliary tract pathology result in a higher morbidity and mortality of the disease, and a large number of emergency operations. Recent studies suggest that the pathophysiology of cholelithiasis is specifically altered in the elderly. Pigmented gallstones, which are more common in the elderly, are thought to result from the action of bacterial enzymes that deconjugate bilirubin and form insoluble bile salts; bacterial contamination of the extrahepatic biliary system is more frequent in elderly patients. Gallbladder stasis may be due to age-related changes in the response of gallbladder musculature to the kinetic action of cholecystokin (CCK), possibly through a decrease in CCK receptor affinity or availability. Other hormonal factors which inhibit choleresis, such as pancreatic polypeptide, are increased with aging as well. Current efforts are being directed toward closer surveillance and discovery of cholelithiasis, and improved outcomes of therapy have been aided by the development of "minimally invasive" approaches to the treatment of cholelithiasis in the elderly.

Adolescent↗
PubMed1986

Cholelithiasis in infancy: resolution of gallstones in three of four infants.

Cholelithiasis in infancy is believed to be a rare finding. It is also held that all cholelithiasis in infancy has a predisposing factor such as hemolysis, prolonged fasting, congenital abnormality of the biliary tree, or the administration of TPN and is associated with severe morbidity and mortality. In the last three years, four infants at our hospital have been found on real-time ultrasonography to have gallstones. Their ages ranged from 3 weeks to 6 months. One patient had a hemolytic disease but the finding of cholelithiasis in the other three patients was incidental. A repeat sonogram in the infant with hemolysis three months after initial recognition and one day before scheduled cholecystectomy revealed spontaneous resolution of the gallstones. This led us to a conservative approach in the other three patients. Two more infants had spontaneous resolution of their gallstones and one child, now aged 16 months, is thriving with a persistent asymptomatic gallstone visible on sonogram.

Cholelithiasis↗
PubMed1987

Parenteral nutrition with associated cholelithiasis: another iatrogenic disease of infants and children.

During the past decade, 246 infants and children treated at the Columbus Children's Hospital have required more than 4 weeks of parenteral nutrition (PN). Of the 178 survivors, 70 returned for evaluation. Sixty-eight either had adequate visualization of the gallbladder by ultrasound or had previous gallbladder surgery (39%). Of 68 children who did not survive, complete postmortem examinations or ultrasound studies were available for 16 (24%). A diagnosis of cholelithiasis was established in 11 of the 84 studied patients (13%). Six of these children (55%) have required cholecystectomy for relief of chronic abdominal pain, pancreatitis, or empyema of the gallbladder. One additional infant underwent cholecystostomy. Two of the four remaining patients are asymptomatic, one has episodes of abdominal colic, and one child expired of chronic hepatic insufficiency as a result of PN-associated cholestasis. Risk factors that predisposed these children to cholelithiasis included short bowel syndrome, lack of an ileocecal valve, and an increased number of abdominal operative procedures (P less than .05). Patients with biliary calculi also had a longer duration of parenteral feeding, and a higher incidence of both PN-associated cholestasis and necrotizing enterocolitis. The intergroup differences for these characteristics, however, did not achieve statistical significance. On the basis of this information, routine ultrasound examinations of the gallbladder are recommended for children maintained on PN for longer than 30 days. All patients presenting with abdominal pain who previously received PN should also be evaluated. Early elective cholecystectomy is suggested for children who develop PN-associated cholelithiasis.

Adolescent↗
PubMed1978

The effect of polyunsaturated fats on bile acid metabolism and cholelithiasis in squirrel monkeys.

Squirrel monkeys (Saimiri sciureus) were fed diets containing safflower oil, butter, or coconut oil and 1 mg cholesterol/cal for 15--17 mo to examine the effect of type of fat on cholelithiasis and bile acid metabolism. Controls were fed low cholesterol diets containing an isocaloric mixture of the three fats. Cholic acid fractional catabolic rate, pool size, chenodeoxycholic acid pool size, and total bile acid pool size and excretion rate were estimated using a modification of Lindstedt's isotopic turnover procedure. The animals fed the safflower oil diet had the highest incidence of cholelithiasis (9/10) when compared to those fed butter (3/7) and coconut oil (1/7). Animals consuming the low cholesterol control diet did not develop gallstones. The butter- and coconut oil-fed groups had significantly (p less than 0.05) expanded bile acid pools when compared to controls, and the butter-fed group had a significantly increased (p less than 0.05) cholic acid fractional catabolic rate. The safflower oil group had the smallest mean bile acid pool and the highest mean lithogenic index of the cholesterol-fed groups. It was concluded that the safflower oil-fed animals had a higher incidence of cholelithiasis than the butter group because, unlike the latter group, they did not compensate for a high cholesterol intake by stimulating bile acid synthesis. The animals consuming coconut oil apparently did not absorb cholesterol to the extent of the other groups and as a result their bile did not become saturated with cholesterol.

Animals↗
PubMed2002

Cholelithiasis in pediatric organ transplantation: detection and management.

The real incidence and the underlying causes of cholelithiasis in pediatric solid organ recipients is probably not exactly known. In addition to well-established risk factors for cholelithiasis, children after heart, kidney, or liver transplantation may develop gallstones due to drug therapy, sepsis, parenteral nutrition, or surgical complications. For pediatric patients, data are very limited and heterogeneous. However, the incidence in pediatric heart recipients seems to be substantially higher compared with kidney or liver graft recipients. In this review article the present data are discussed focusing on incidence, detection, and management of cholelithiasis in pediatric organ transplantation. In general, surgery is the therapy of choice in symptomatic patients; however, the pharmacological profile of ursodeoxycholic acid and the first results on its clinical impact are promising. The value of prophylactic therapy with ursodeoxycholic acid must be determined in further studies.

Child↗
PubMed2001

Cholelithiasis and Gilbert's syndrome in homozygous beta-thalassaemia.

Cholelithiasis has been reported with a variable incidence in homozygous beta-thalassaemia, the reasons for which have only partially been defined. Disease-associated factors or specific modifier genes may be implicated. We assessed the prevalence of cholelithiasis and the effect of co-inherited Gilbert's syndrome genotype on its development in 261 thalassaemia major (TM) and 35 thalassaemia intermedia (TI) patients. Cholelithiasis was found in 20.3% of TM and in 57.1% of TI patients. Its incidence was higher (P < 0.05) in patients homozygous for the (TA7) motif in the promoter of the UGT1-A1 gene, the genotype associated with Gilbert's syndrome, which seems to be a risk factor for the development of gallstones in TM and TI patients.

Adolescent↗
PubMed1986

Cholelithiasis in children with congenital spherocytosis.

Cholelithiasis was diagnosed in two children with congenital spherocytosis of 7 and 9 years of age. Surgery was performed at age 10 and 14, respectively. The presence of gallstones should be considered in patients with congenital spherocytosis even under the age of 10. Various radiologic methods and ultrasonography are useful in the diagnosis of cholelithiasis in children as well as in adults. Once the diagnosis of cholelithiasis is established the treatment of choice is cholecystectomy and splenectomy at the same operation. To perform both procedures an upper midline incision proved to be satisfactory.

Adolescent↗
PubMed1984

[Cholelithiasis and acute pancreatitis].

In acute biliary pancreatitis it is the acute inflammatory pancreatitis rather than the cholelithiasis which dominates. Among 2161 patients with cholelithiasis seen from 1972 to 1983, 21% were found to have choledochal stones at operation. A total of 121 patients (5.6%) had "associated pancreatitis" according to the history as well as clinical and intra-operative findings. Frequency and site of cholelithiasis, as well as treatment and its results were compared with those in a group of patients with "acute pancreatitis of biliary origin" (145 of 447 patients from 1972 to 1983). Choledocholithiasis occurred equally often in both groups (36-39%). Impacted papillary concrements were found in 2.9% of patients with acute biliary pancreatitis, in 7.4% of those with "associated pancreatitis". Early intervention is practised only in case of impacted papillary stones, preferably by endoscopic papillotomy. Otherwise the timing of any operative procedure will be determined entirely by the severity and course of the acute pancreatitis.

Acute Disease↗
PubMed1997

Cholelithiasis and pancreatic cancer. A case-control study.

To study the possible association between pancreatic cancer and cholelithiasis, we conducted a retrospective case-control study. Abdominal ultrasound of 100 consecutive cases of pancreatic cancer and that of 140 age- and gender-matched control subjects were examined by 2 observers who did not know the diagnosis. Thirty-seven patients with pancreatic cancer had cholelithiasis (37%), as compared with 23 (16%) of the control group (p < 0.001). The increased prevalence of gallstones in patients with pancreatic carcinoma remained significant when either male or female patients were compared (p < 0.02), as well as in the various age groups studied. For example, 30 (43.5%) of 69 patients 65 years of age and older had cholelithiasis versus 21 (22%) of 95 control subjects (p < 0.005). Thus, patients with pancreatic cancer were found to have a higher prevalence of gallstone disease than expected in a matched control population (relative risk, 2.2; 95% confidence interval, 1.2-4.3). This finding does not establish a causal link; however, the possibility should be pursued, more so because gallstones have been identified previously as likely risk factors for cancer in other parts of the biliary-pancreatic tract.

Aged↗
PubMed2004

Increased prevalence of cholelithiasis in Gaucher disease: association with splenectomy but not with gilbert syndrome.

GOALS: The purpose of this study is to ascertain the incidence of gallstones among adult patients with type 1 Gaucher disease and whether the presence of the UDPGT1 polymorphism (Gilbert syndrome), increases the incidence of gallstones. BACKGROUND: Cholelithiasis was been observed among patients with type I Gaucher disease with variable frequency. Too, studies have addressed the possibility of an association between Gilbert syndrome and formation of bilirubinate gallstones in hereditary spherocytosis wherein, like Gaucher disease, there is hemolysis of blood cell membranes. METHODS: Medical records of all adult patients with type 1 disease in a referral clinic were reviewed for evidence of gallstones or cholecystectomy. Blood samples were collected for molecular analysis for Gilbert syndrome. RESULTS: Of 323 adult patients, 82 patients (25.4%), 54 women (65.9%) and 28 men (34.1%), had evidence of gallbladder disease (P < 0.001 relative to normal white controls). There was a statistically significant increase (P < 0.001) for all groups above the ages of 20 years other than for men aged 40 to 49 years. There was a statistically significant association between splenectomy and both cholelithiasis (P = 0.022) and Gilbert syndrome (P = 0.002). CONCLUSIONS: This study highlights an increase incidence of cholelithiasis but not Gilbert syndrome among patients with Gaucher disease. Storage of glycolipid per se or an immune reaction to storage, may explain these findings.

Adult↗
PubMedDate not supplied

Cholelithiasis in an infant with polycythemia.

An 11-week-old infant with polycythemia presented with cholestasis secondary to cholelithiasis. It is likely that hemolysis secondary to polycythemia predisposed our patient to cholelithiasis. We suggest that polycythemia may be a new cause of cholelithiasis in infancy.

Cholelithiasis↗
PubMed1995

Sequential endoscopic/laparoscopic management of sickle hemoglobinopathy-associated cholelithiasis and suspected choledocholithiasis.

We reviewed the medical records of 17 patients with sickle hemoglobinopathy-associated cholelithiasis who were candidates for laparoscopic cholecystectomy (LC) between 1991 and 1994. Eight patients with suspected choledocholithiasis (CDL) were identified, all of whom had preoperative endoscopic retrograde cholangiopancreatography (ERCP), which revealed CDL in 3 patients (18%), all of whom had endoscopic ductal clearance. Choledocholithiasis was suspected because of hyperbilirubinemia or serum liver enzyme abnormalities. Incremental hyperbilirubinemia exceeding "baseline" values by > 5 mg/dL was the best predictor of CDL. Subsequent LC was successful with discharge within 2 days of LC in all but one patient, who was converted to open cholecystectomy. This small series suggests that in sickle hemoglobinopathy patients with cholelithiasis (1) CDL is relatively common among patients with an increase above baseline hyperbilirubinemia, (2) bile duct dilatation, alkaline phosphatase, and serum aminotransferase levels are poor predictors of CDL, and (3) sequential endoscopic/laparoscopic management of cholelithiasis and suspected CDL is successful.

Adult↗
PubMed1993

Biliary bile acids in cholelithiasis and carcinoma of the gall bladder.

The role of biliary deoxycholate as an endogenous carcinogen and the possible association between cholelithiasis and the subsequent development of carcinoma of the gall bladder is unclear. This paper describes biliary bile acid analysis performed on three groups of patients, 10 with cholelithiasis, 10 with carcinoma of the gall bladder and 10 control patients. This is the first report of bile acid changes in carcinoma of the gall bladder. In these 30 patients the total bile acids concentration was highly variable (11.44-53.68 mg/ml). The mean ratio of primary to secondary bile acids was 3.5:1. This ratio was, however, significantly higher in cholelithiasis than in the control group (5.34:1; P < 0.001); patients with carcinoma of the gall bladder had significantly higher secondary bile acids (1:1; P < 0.001). This is due to a marked increase in the secondary bile acids and indicates that raised biliary deoxycholate concentrations are present in patients with carcinoma of the gall bladder and therefore may well be a factor in carcinogenesis.

Bile Acids and Salts↗
PubMed1997

Cholelithiasis, cholecystitis, and common bile duct stones.

Cholecystitis and cholelithiasis are being recognized with increasing frequency in infancy, childhood, and adolescence. Hematologic disorders account for a large proportion of cases; however, in most cases the etiology is uncertain. Infants and children are noted with stones in association with total parenteral nutrition, prolonged fasting, or ileal resection. Biliary dyskinesia, a disorder of impaired gallbladder contractility, is being recognized with increased frequency in late childhood and teenage years. Spontaneous stone resolution is frequently noted in infancy, and a period of observation is appropriate in the absence of symptoms. Laparoscopic cholecystectomy is the procedure of choice for symptomatic cholelithiasis and biliary dyskinesia. Common bile duct stones are unusual in children, occurring in 2% to 6% of children with cholelithiasis, often in association with obstructive jaundice and pancreatitis. Endoscopic retrograde cholangiography with stone extraction performed before or after laparoscopic cholecystectomy is the procedure of choice in this setting.

Adolescent↗
PubMed1985

Experience with cholelithiasis in patients with sickle cell disease in Nigeria.

Sickle cell anemia, like other chronic hemolytic states, predisposes to cholelithiasis. However, it seems that other factors, apart from the consequent hyperbilirubinemia, contribute to this predisposition. This concept is supported by the fact that while cholelithiasis is very common among North American sickle cell patients, it is not so common in African patients. It is now believed that African sickle cell patients are protected from developing gallstones because of their low dietary intake of cholesterol and low intake of refined fiber-depleted foods. A review of all the published work on cholelithiasis, in Nigerians in general and sickle cell patients in particular, is presented in this article. A comparison is made with similar studies carried out in North America.

Adolescent↗
PubMed2003

High incidence of early cholelithiasis detected by ultrasonography in children and young adults with hereditary spherocytosis.

OBJECTIVES: Retrospective cholecystography studies in adults with hereditary spherocytosis (HS) suggested detectable gallstones in 37% to 43% of patients. Since longitudinal studies using biliary ultrasonography are unavailable, the aim of the present study was to determine the incidence of gallstone disease, as detected by biliary ultrasonography, in children and young adults with HS. As individuals with HS who co-inherit Gilbert syndrome have a greater risk of developing gallstones, uridine diphosphate-glucuronyl transferase (UGT-1A) gene polymorphism was also determined. PATIENTS AND METHODS: The authors retrospectively evaluated 44 patients aged 1.4 to 22 years with HS, 12 (27%) of whom underwent splenectomy. Ultrasonography was performed annually starting at the age of 4 years or at the time of diagnosis, if later. RESULTS: Of the 44 patients, 18 (41%) developed cholelithiasis as demonstrated by gallbladder ultrasonography. In most patients (94%) the test first proved positive at age 4 to 13 years. Patients with HS and Gilbert syndrome tended to be younger at the time of cholelithiasis. CONCLUSIONS: Early cholelithiasis was detected in children and young adults with HS. To identify this complication, the authors recommend early annual biliary ultrasonography in HS children, starting at about 4 years of age. In patients with Gilbert syndrome, closer follow-up may be indicated.

Adolescent↗