E-ISSN 2148-5607
Original Article
A retrospective review of children with gallstone: Single-center experience from Central Anatolia
1 Department of Pediatric Gastroenterology, Hepatology and Nutrition, Bezmiâlem Vakif University Faculty of Medicine, İstanbul, Turkey  
2 Department of Pediatrics, Dr. Sami Ulus Maternity and Children’s Health and Diseases Training and Research Hospital, Ankara, Turkey  
3 Department of Pediatric Surgery, Dr. Sami Ulus Maternity and Children’s Health and Diseases Training and Research Hospital, Ankara, Turkey  
Turk J Gastroenterol 2014; 25: 46-53
DOI: 10.5152/tjg.2014.3907
Key Words: Children, gallstone, complication, risk factors
Abstract

Background/Aims: To evaluate children with gallstone in respect to demographic features, type of presentation, predisposing risk factors, laboratory features, complications, and outcome.

 

Materials and Methods: Overall, 124 children with sonographically diagnosed gallstone were stratified into group 1 (symptomatic) and group 2 (asymptomatic). The data on demographic features, predisposing risk factors, laboratory features, complications, and outcome were collected from medical charts and compared by using convenient statistical methods.

 

Results: There were 76 (61%) children in group 1. Females were significantly older than males at the time of diagnosis (p=0.001). After adjusting for age and sex, asymptomatic presentation was associated with hemolytic anemia (r=346, <0.001) and being an oncologic patient (r=248, p=0.006). No risk factor was specifically associated with having a symptomatic presentation. Sixteen children (12.9%) developed complications: 14 (18.4%) in group 1 and 2 (4.2%) in group 2 (p=0.027). Gallstone resolution was detected in 20 (29.4%) and 10 children (23.3%) in groups 1 and 2, respectively (p=0.477). Resolution was observed in 43.8% of children with ceftriaxone-associated gallstone. The rate of resolution with ursodeoxycholic acid (UDCA) was similar to that observed with expectant management. Gallstone resolution was evident in 9 infants (50.0%) and was significantly higher than children over 2 years of age (21 out of 106 children, 19.8%) (p=0.006). The most important factor associated with gallstone resolution was to be an infant (<2 years of age) at the time of diagnosis (OR: 3.1; 95% CI: 1.1-8.8; p=0.034).

 

Conclusion: Ceftriaxone-associated gallstones are most likely to resolve but do not always undergo spontaneous resolution. UDCA treatment seems to be ineffective. Young age is a favorable factor for gallstone resolution. The rate of complications in children with asymptomatic presentation is considerably low. Thus, clinical follow-up rather than surgical intervention is suggested in children with asymptomatic presentation and in infants.

 


 

Turkish

 

Başlık: Safra taşı olan çocukların geriye dönük değerlendirilmesi

 

Anahtar kelimeler: Çocuk, safra taşı, risk faktörleri, komplikasyon

 

Arkaplan/Amaç: Safra taşı saptanan çocukların demografik ve klinik özelliklerinin değerlendirilmesi.
 

Yöntemler ve Gereçler: Ultrason ile safra taşı saptanan 124 çocuk prezentasyon şekline göre group 1 (semptomatik) ve group 2’ye (asemptomatik) ayrıldı. Demografik özellikler, risk faktörleri, laboratuar özellikleri, komplikasyon ve izlem sonuçları uygun istatistiksel yöntemler kullanılarak karşılaştırıldı
 

Bulgular: Grup 1’de 7 (%61) hasta vardı. Tanı anında kızların mediyan yaşı erkeklerden daha büyüktü (p=0.001). Asemptomatik prezentasyon hemolitik anemi (r=346, <0.001) ve onkolojik hasta olma (r=248, p=0.006) ile ilişkili idi. Semptomatik prezentasyon herhangi bir risk faktörü ile ilişkili bulunmadı. Komplikasyon gelişen 16 (%12.9) hastanın 14’ü (%18.4) semptomatik, 2’si (%4.2) asemptomatik gurupta idi (p=0.027). Grup 1’de 20 (29.4%) grup 2’de 10 (23.3%) çocukta safra taşı rezolüsyonu gözlendi (p=0.477). Seftriakson ilişkili safra taşı olan hastaların %43’ünde safra taşı rezolüsyonu vardı. Ursodeoksikolik asit (UDKA) alanlar ile almayanlarda rezolüsyon sıklığı benzer bulundu. Bebeklik yaş gurubundaki 18 hastanın 9’unda (%50) rezolüsyon saptandı ve bu oran 2 yaş üzeri hastalardan anlamlı olarak yüksekti (%19.8, p=0.006). Bebeklik yaş gurubunda olmak safra taşı rezolüsyonunda en etkili faktördü (OR: 3.1, 95% CI: 1.1-8.8; p=0.034)
 

Sonuç: Seftriakson ilişkili safra taşları çoğunlukla rezolüsyona uğramakla beraber bu bir kural değildir. UDKA safra taşı tedavisinde etkin görünmemektedir. Bebeklik yaş gurubunda olmak safra taşı rezolüsyonunda en etkili faktördür. Asemptomatik hastalarda komplikasyon nadirdir. Bu nedenle başvuruda asemptomatik ve bebeklik yaş gurubunda olanlarda klinik izlem önerilir.

 

Key Words
Authors
All
Reviewer's Corner
Author’s Corner
Survey
AVES | Copyright © 2019 Turkish Society of Gastroenterology | Latest Update: 30.05.2019