- Case Report
- Open Access
Calcified gallstone in a 3 year-old boy: a case report
© Barthel et al.; licensee BioMed Central Ltd. 2012
- Received: 21 June 2012
- Accepted: 10 August 2012
- Published: 13 August 2012
Gallstones are relatively rare in children. At-risk populations include patients suffering from hemolysis syndromes. Regardless of etiology, these patients usually will present with postprandial abdominal pain, and ultrasonography is the mainstay of diagnosis. However, some gallstones are radiopaque and can be visualized on plain abdominal radiography.
We present the uncommon but classic plain x-ray finding of a calcified gallstone in a 3 year-old Hispanic boy. He was treated with elective laparoscopic cholecystectomy.
Cholelithiasis is rare in children, and calcified stones that will appear on plain abdominal x-rays are even rarer. If symptomatic, cholecystectomy by a pediatric surgeon is the treatment of choice. We discuss some of the recent developments in treatment of this condition in this patient population.
- Laparoscopic Cholecystectomy
- Sickle Cell Disease
- Pigment Stone
- Symptomatic Cholelithiasis
Although not common in children, gallstones are seen with increased incidence in pediatric patients with hematologic disorders . In adults, an increased risk of gallstones is seen with obesity . Given the rising incidence of obesity in children in the United States, it is likely that cholelithiasis will also increase in this population with time . There are relatively sparse reports in the literature of a calcified gallstone in the pediatric population .
Fifteen percent of gallstones are sufficiently calcified to be radiodense enough to be visualized on plain radiographs, and of these, two thirds are pigment stones . In general, gallstones are uncommon in children, with patients under 15 comprising only 0.1-0.2% of the incidence of the disease . In the pediatric population, pigment stones containing bilirubin salts are more common . These types of stones are associated with hemolytic disorders, most commonly sickle cell anemia . In our patient, after his cholecystectomy a hematologic workup was recommended to his primary physician. Laparoscopic cholecystectomy can be safely performed in the case of symptomatic cholelithiasis in this population. It is the treatment of choice for gallstones in children with sickle cell disease . Moreover, it can be safely performed as an outpatient procedure, rather than having to incur the additional costs of an overnight hospital stay . More recently, the use of a single-incision approach, in place of the traditional 4-trocar laparoscopic cholecystectomy employed here, has been applied to pediatric patients. These authors note that the single-incision method can be used in children for a variety of laparoscopic procedures, and though it carries some drawbacks, many of these can be overcome by employing specially adapted instruments .
Despite its relative rarity in comparison to adults, cholelithiasis must always be on the differential diagnosis with a childhood complaint of postprandial abdominal pain. Cholecystectomy is the appropriate treatment for symptomatic cholelithiasis, especially so in children with sickle cell disease or other hemolytic disorders. It can be performed safely in the outpatient setting, and the emerging technique of single-incision laparoscopy will likely play an increasingly important role in its management in carefully selected patients.
Written informed consent was obtained from this minor patient’s parents for publication of this case report and the accompanying images. A de-identified copy of the written consent is available for review by the Editor-in-Chief of this journal.
We thank the Children’s Hospital Los Angeles Division of Pediatric Surgery, the Department of Radiology, and the Department of Emergency and Transport Medicine for educational and logistical support. ERB is supported by the California Institute for Regenerative Medicine, grant number TCS-007117.
- Mehta S, Lopez ME, Chumpitazi BP, Mazziotti MV, Brandt ML, Fishman DS: Clinical characteristics and risk factors for symptomatic pediatric gallbladder disease. Pediatrics. 2011, 129: e82-e88.PubMedView ArticleGoogle Scholar
- Stinton LM, Myers RP, Shafer EA: Epidemiology of gallstones. Gastroenterol Clin N Am. 2010, 39: 157-169. 10.1016/j.gtc.2010.02.003.View ArticleGoogle Scholar
- Koebnick C, Smith N, Black MH, Porter AH, Richie BA, Hudson S, Gililland D, Jacobsen SJ: Longstreth GF. Pediatric obesity and gallstone disease: results from a cross-sectional study of over 510,000 youth. J Pediatr Gastroenterol Nutr. 2012, epub ahead of printGoogle Scholar
- Rudisill H: X-ray visualization of a calcified gallstone in a child seven years old. Radiology. 1931, 16: 942-944.View ArticleGoogle Scholar
- Johnston DE, Kaplan MM: Pathogenesis and treatment of gallstones. NEJM. 1993, 328: 412-421. 10.1056/NEJM199302113280608.PubMedView ArticleGoogle Scholar
- Punia RPS, Garg S, Bisht B, Dalal U, Mohan H: Clinico-pathological spectrum of gallbladder disease in children. Acta Paediatr. 2010, 99: 1561-1564. 10.1111/j.1651-2227.2010.01876.x.PubMedView ArticleGoogle Scholar
- Poddar U: Gallstone disease in children. Indian Peds. 2010, 47: 945-953. 10.1007/s13312-010-0159-2.View ArticleGoogle Scholar
- Currò G, Meo A, Ippolito D, Pusiol A, Cucinotta E: Asymptomatic cholelithiasis in children with sickle cell disease: early or delayed cholecystectomy?. Ann Surg. 2007, 245: 126-129. 10.1097/01.sla.0000242716.66878.23.PubMedPubMed CentralView ArticleGoogle Scholar
- Schinasi DA, Mistry RD: Cholelithiasis in a toddler with sickle cell disease. Pediatr Emerg Care. 2011, 27: 533-534. 10.1097/PEC.0b013e31821dc6a1.PubMedView ArticleGoogle Scholar
- Méndez K, Sabater R, Chinea E, Lugo-Vicente H: Is there a safe advantage in performing outpatient laparoscopic cholecystectomy in children?. J Pediatr Surg. 2007, 42: 1333-1336. 10.1016/j.jpedsurg.2007.03.028.PubMedView ArticleGoogle Scholar
- Hansen EN, Muensterer OJ, Georgeson KE, Harmon CM: Single-incision pediatric endosurgery: lessons learned from our first 224 laparoendoscopic single-site procedures in children. Pediatr Surg Int. 2011, 27: 643-648. 10.1007/s00383-010-2735-x.PubMedView ArticleGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.