Cholelithiasis and chronic cholecystitis in a ten-year-old-boy: a case report

Carissa Lidia; I Gusti Ngurah Sanjaya Putra; I Putu Gede Karyana; Ni Nyoman Metriani Nesa; I Made Darmajaya; Kadek Deddy Ariyanta

doi:10.15562/ism.v11i3.684

Cholelithiasis and chronic cholecystitis in a ten-year-old-boy: a case report

Carissa Lidia ,

I Gusti Ngurah Sanjaya Putra ,

I Putu Gede Karyana ,

Ni Nyoman Metriani Nesa ,

I Made Darmajaya ,

Kadek Deddy Ariyanta ,

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DOI: https://doi.org/10.15562/ism.v11i3.684 |
Published: 2020-12-01

Abstract

Background: Cholelithiasis in children is uncommon and challenging to diagnose because the patient is often asymptomatic and the clinical feature doesn't clearly depict cholelithiasis or cholecystitis. This case study aims to describe a rare case of cholelithiasis with chronic cholecystitis in a ten-year-old boy.

Case Presentation: A ten-year-old boy presented with umbilical pain, nausea, and emesis. Physical examination showed there is no tenderness in all abdominal quadrants with a negative Murphy sign. Laboratory results revealed elevated white blood cell count 20.42x10³/?L, elevated erythrocyte sedimentation rate 47.2 mm/hour, normal liver function tests, urine, and stool analysis. He underwent transabdominal ultrasound twice. The latest transabdominal ultrasound showed cholelithiasis, free fluid around the pelvic region due to suspected visceral organ perforation. Laparoscopic cholecystectomy was performed without complication. The result of pathology anatomy examination was chronic cholecystitis. The patient was discharged 3 days after surgery in good condition. The long-term prognosis of the patient was good.

Conclusion: Even though the patient is male with good nutritional status (not obese), the patient was in the mean age that was identified as a key contributor to this disease. Ultrasonography examination is a screening modality that is still an excellent diagnostic tool with 95% accuracy even though it is highly operator dependent. Laparoscopic cholecystectomy is a gold standard for management even in children with decreased pain and shorter lengths of stay in the hospital.

References

Stinton LM, Myers RP, Shaffer EA. Epidemiology of gallstones. Gastroenterol Clin North Am. 2010;39(2):157-vii.
Della Corte C, Falchetti D, Nebbia G, Calacoci M, Pastore M, Francavilla M, et al. Management of cholelithiasis in Italian children: a national multicenter study. World J Gastroenterol. 2008;14(9):1383-1388.
Poddar U. Gallstone disease in children. Indian Pediatr. 2010;47(11):945-953.
Reif S, Sloven DG, Lebenthal E. Gallstones in children. Characterization by age, etiology, and outcome. Am J Dis Child. 1991;145(1):105-108.
Ulin AW, Nosal JL, Martin WL. Cholecystitis in childhood; associated obstructive jaundice. Surgery. 1952;31(2):312-326.
Hagberg B, Svennerholm L, Thoren L. Cholelithiasis in childhood. A follow-up study with special reference to heredity, constitutional factors and serum lipids. Acta Chir Scand. 1962;123:307-315.
Franklin AL, Qureshi FG, Nadler EP. Management of Gallstones in the Pediatric Patient. In: Acute Cholecystitis. Springer, Cham. 2015, p. 197-206.
Hussain MI, Khan AF. Outcome of laparoscopic cholecystectomy in acute and chronic cholecystitis. Saudi Med J. 2006;27(5):657-660.
Poffenberger CM, Gausche-Hill M, Ngai S, Myers A, Renslo R. Cholelithiasis and its complications in children and adolescents: update and case discussion. Pediatr Emerg Care. 2012;28(1):68-78.
Chen YC, Chiou C, Lin MN, Lin CL. The prevalence and risk factors for gallstone disease in taiwanese vegetarians. PLoS One. 2014;9(12):e115145.
Mehta S, Lopez ME, Chumpitazi BP, Mazziotti MV, Brandt ML, Fishman DS. Clinical characteristics and risk factors for symptomatic pediatric gallbladder disease. Pediatrics. 2012;129(1):e82-e88.
P Blackwood B, Grabowski J. Chronic cholecystitis in the pediatric population: an underappreciated disease process. Gastroenterol Hepatol Bed Bench. 2017;10(2):125-130.
Freitas ML, Bell RL, Duffy AJ. Choledocholithiasis: evolving standards for diagnosis and management. World J Gastroenterol. 2006;12(20):3162-3167.
Ahmed M, Diggory R. The correlation between ultrasonography and histology in the search for gallstones. Ann R Coll Surg Engl. 2011;93(1):81-83.
Varghese JC, Liddell RP, Farrell MA, Murray FE, Osborne DH, Lee MJ. Diagnostic accuracy of magnetic resonance cholangiopancreatography and ultrasound compared with direct cholangiography in the detection of choledocholithiasis. Clin Radiol. 2000;55(1):25-35.
Zaka-ur-Rab A, Zaka-ur-Rab Z, Fareed R, Ahmed I. Cholangitis and choledocholithiasis after repair of duodenal atresia: a case report. Acta Med Iran. 2011;49(4):269-274.
Mou D, Tesfasilassie T, Hirji S, Ashley SW. Advances in the management of acute cholecystitis. Ann Gastroenterol Surg. 2019;3(3):247-253.
Acar T, Kamer E, Acar N, et al. Laparoscopic cholecystectomy in the treatment of acute cholecystitis: comparison of results between early and late cholecystectomy. Pan Afr Med J. 2017;26:49.
Saia M, Mantoan D, Buja A, et al. Time trend and variability of open versus laparoscopic cholecystectomy in patients with symptomatic gallstone disease. Surg Endosc. 2013;27(9):3254-3261.
P Blackwood B, Grabowski J. Chronic cholecystitis in the pediatric population: an underappreciated disease process. Gastroenterol Hepatol Bed Bench. 2017;10(2):125-130.
Kouloura A, Sgourakis G, Lanitis S, Sourtse G, Karaliotas C, Pintireki A, et al. Enriched view of postcholecystectomy syndrome: Nowadays and in former times. Hellenic Journal of Surgery. 2015;87(2):156-64.

[1] Stinton LM, Myers RP, Shaffer EA. Epidemiology of gallstones. Gastroenterol Clin North Am. 2010;39(2):157-vii.

[2] Della Corte C, Falchetti D, Nebbia G, Calacoci M, Pastore M, Francavilla M, et al. Management of cholelithiasis in Italian children: a national multicenter study. World J Gastroenterol. 2008;14(9):1383-1388.

[3] Poddar U. Gallstone disease in children. Indian Pediatr. 2010;47(11):945-953.

[4] Reif S, Sloven DG, Lebenthal E. Gallstones in children. Characterization by age, etiology, and outcome. Am J Dis Child. 1991;145(1):105-108.

[5] Ulin AW, Nosal JL, Martin WL. Cholecystitis in childhood; associated obstructive jaundice. Surgery. 1952;31(2):312-326.

[6] Hagberg B, Svennerholm L, Thoren L. Cholelithiasis in childhood. A follow-up study with special reference to heredity, constitutional factors and serum lipids. Acta Chir Scand. 1962;123:307-315.

[7] Franklin AL, Qureshi FG, Nadler EP. Management of Gallstones in the Pediatric Patient. In: Acute Cholecystitis. Springer, Cham. 2015, p. 197-206.

[8] Hussain MI, Khan AF. Outcome of laparoscopic cholecystectomy in acute and chronic cholecystitis. Saudi Med J. 2006;27(5):657-660.

[9] Poffenberger CM, Gausche-Hill M, Ngai S, Myers A, Renslo R. Cholelithiasis and its complications in children and adolescents: update and case discussion. Pediatr Emerg Care. 2012;28(1):68-78.

[10] Chen YC, Chiou C, Lin MN, Lin CL. The prevalence and risk factors for gallstone disease in taiwanese vegetarians. PLoS One. 2014;9(12):e115145.

[11] Mehta S, Lopez ME, Chumpitazi BP, Mazziotti MV, Brandt ML, Fishman DS. Clinical characteristics and risk factors for symptomatic pediatric gallbladder disease. Pediatrics. 2012;129(1):e82-e88.

[12] P Blackwood B, Grabowski J. Chronic cholecystitis in the pediatric population: an underappreciated disease process. Gastroenterol Hepatol Bed Bench. 2017;10(2):125-130.

[13] Freitas ML, Bell RL, Duffy AJ. Choledocholithiasis: evolving standards for diagnosis and management. World J Gastroenterol. 2006;12(20):3162-3167.

[14] Ahmed M, Diggory R. The correlation between ultrasonography and histology in the search for gallstones. Ann R Coll Surg Engl. 2011;93(1):81-83.

[15] Varghese JC, Liddell RP, Farrell MA, Murray FE, Osborne DH, Lee MJ. Diagnostic accuracy of magnetic resonance cholangiopancreatography and ultrasound compared with direct cholangiography in the detection of choledocholithiasis. Clin Radiol. 2000;55(1):25-35.

[16] Zaka-ur-Rab A, Zaka-ur-Rab Z, Fareed R, Ahmed I. Cholangitis and choledocholithiasis after repair of duodenal atresia: a case report. Acta Med Iran. 2011;49(4):269-274.

[17] Mou D, Tesfasilassie T, Hirji S, Ashley SW. Advances in the management of acute cholecystitis. Ann Gastroenterol Surg. 2019;3(3):247-253.

[18] Acar T, Kamer E, Acar N, et al. Laparoscopic cholecystectomy in the treatment of acute cholecystitis: comparison of results between early and late cholecystectomy. Pan Afr Med J. 2017;26:49.

[19] Saia M, Mantoan D, Buja A, et al. Time trend and variability of open versus laparoscopic cholecystectomy in patients with symptomatic gallstone disease. Surg Endosc. 2013;27(9):3254-3261.

[20] P Blackwood B, Grabowski J. Chronic cholecystitis in the pediatric population: an underappreciated disease process. Gastroenterol Hepatol Bed Bench. 2017;10(2):125-130.

[21] Kouloura A, Sgourakis G, Lanitis S, Sourtse G, Karaliotas C, Pintireki A, et al. Enriched view of postcholecystectomy syndrome: Nowadays and in former times. Hellenic Journal of Surgery. 2015;87(2):156-64.

Cholelithiasis and chronic cholecystitis in a ten-year-old-boy: a case report

Abstract

References

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