Gallstones in Children

February 27, 2021 By Dr. Ashish Prasad

Gallstones in Children

Gallstones, also known as cholelithiasis, are solid deposits of digestive fluid in the gallbladder, a small organ that sits just below the liver.Normally, bile drains from the liver into the small intestine where it helps digest food. Between meals, bile is stored in the gallbladder. Sometimes bile hardens and forms gallstones. Gallstones range in size from small grains to the size of a lemon.Although the condition is more common in adults, about 2 percent of children of children are diagnosed with gallstones. The incidence is increasing especially in the urban areas

Many people have gallstones without realizing it. Sometimes, however, the gallbladder becomes inflamed or a gallstone moves into a duct or passageway, creating a blockage. When this happens, the child may have abdominal pain and nausea, vomiting and/or fever.

There are different types of gallstones:

  • Pigment gallstones are the most common type of gallstone in children. They form when bile contains too much bilirubin, a by-product of the body’s natural breakdown of red blood cells.
  • Cholesterol gallstones are the most common form of gallstone in adults, but now are common in children as well due to obesity and consumption highly saturated foods. They form when bile mixes with cholesterol and hardens.

Girls are at higher risk than boys of developing gallstones. Other than gender, a number of factors can cause gallstones to form. The most common causes in children include:

  • abnormalities in the production of red blood cells
  • prolonged fasting due to illness
  • long-term parenteral nutrition

Often, people have gallstones but no symptoms. If gallstones become symptomatic, the gallbladder typically needs to be removed. Symptoms often flare up after meals, especially meals high in fat or grease.

Symptoms include:

  • pain in the upper right abdomen
  • nausea
  • vomiting
  • fever

Gallstones must be treated with surgery to remove the gallbladder.

  • There are no medical treatments of symptomatic gallstones
    • Sometimes medicines are used to dissolve the stones especially if they are asymptomatic or the gall bladder is functioning normally.
  • Stones will almost always reform in the gallbladder if it is not removed.

It's called laparoscopic cholecystectomy, and it's a minimally invasive procedure and is done under general anaesthesia. During surgery four smallband-aid sized incisions are made on the child's abdomen, through which a telescope is passed to observe the operation as it is performed with instruments placed through the other three openings.

Rarely, an "open" procedure through an incision below the ribs may be necessary. This may be required if there is scarring, inflammation, bleeding or unusual anatomy of the common bile duct which prevents safe performance of the laparoscopy.

After surgery: 

  • The child may drink fluids the evening after the operation.
  • The child is given pain medicine through the IV the evening after the operation.
  • The child is given a prescription for pain medication at time of discharge.
  • The child will have four small dressings on the abdomen which will be removed on follow up

For more information visit www.paedsurgeryindelhi.com