Children can develop gallstones, a condition known medically as cholelithiasis. Gallstones are hardened deposits of digestive fluid that form within the gallbladder, a small organ located beneath the liver. While historically considered rare in the pediatric population, the incidence of gallstones in children is now rising, particularly among adolescents. This increase is often attributed to better diagnostic imaging and a growing prevalence of specific risk factors in young people.
Specific Causes and Risk Factors in Pediatric Patients
The formation of gallstones in children often stems from underlying medical conditions that alter the composition of bile. A significant cause involves hemolytic disorders, such as Sickle Cell Disease or hereditary spherocytosis, which lead to the rapid breakdown of red blood cells. This process increases the amount of unconjugated bilirubin in the bile, which then combines with calcium to form black pigment stones. These pigment stones account for a large percentage of gallstones found in pediatric patients, with the prevalence of gallstones in children with Sickle Cell Disease being nearly double that of the general population.
In contrast, non-hemolytic causes, which are becoming more common, typically result in cholesterol stones, similar to those seen in adults. The growing epidemic of childhood obesity is a major contributor to this shift, as excess weight and rapid weight loss can disrupt the balance of cholesterol in the bile.
Furthermore, children who are dependent on Total Parenteral Nutrition (TPN), an intravenous feeding method, are at an elevated risk. TPN can lead to the gallbladder becoming stagnant because it is not stimulated to empty, allowing bile to thicken into sludge and eventually form stones.
Congenital anomalies affecting the bile ducts, though less common, can also predispose a child to gallstone development. Certain genetic conditions, like progressive familial intrahepatic cholestasis, affect bile flow and composition. Additionally, some medications, such as the antibiotic ceftriaxone, have been linked to a reversible condition called biliary pseudolithiasis, where a temporary sludge forms in the gallbladder.
Identifying Symptoms in Children
The symptoms of gallstones in children can be vague and non-specific, making the condition sometimes difficult to identify, especially in younger children. The most common complaint is abdominal pain, which is often described as being in the upper right quadrant or the middle upper part of the belly, just beneath the rib cage. This pain, known as biliary colic, can be sharp, crampy, or dull, and may radiate to the back or the right shoulder blade.
The pain typically worsens after meals, particularly those high in fat, as this triggers the gallbladder to contract. Children may also experience associated symptoms like nausea and vomiting, which can be mistakenly attributed to other digestive issues. In infants and toddlers, the presentation may be even less clear, sometimes showing only irritability or non-specific feeding intolerance.
If a gallstone moves and causes a blockage in the bile duct, the child may exhibit more distinct signs of obstruction. These signs can include jaundice (a yellowish tint to the skin and eyes), caused by the buildup of bilirubin. Parents might also observe dark urine and pale or clay-colored stools, both of which indicate that bile is not flowing correctly into the intestine.
Medical Procedures for Diagnosis and Treatment
The primary medical procedure used to confirm the presence of gallstones in children is abdominal ultrasonography. This non-invasive imaging technique uses sound waves to produce detailed pictures of the gallbladder and bile ducts, allowing clinicians to visualize the stones and check for signs of inflammation, such as a thickened gallbladder wall. Blood tests are also routinely performed to assess liver function and check for elevated levels of bilirubin and liver enzymes, which can signal a blockage or inflammation.
Treatment for pediatric gallstones is highly individualized and depends primarily on whether the child is experiencing symptoms. For children with asymptomatic gallstones—those who have stones but no pain or complications—a strategy of watchful waiting with periodic clinical and ultrasound surveillance is often employed. A notable exception to this approach is in children with Sickle Cell Disease, for whom cholecystectomy is generally recommended even without symptoms to prevent future complications.
For children who have symptomatic gallstones, the definitive treatment is surgical removal of the gallbladder, a procedure called a cholecystectomy. The operation is most commonly performed using a laparoscopic technique, which involves small incisions and the use of a camera, leading to a faster recovery. This procedure eliminates the source of the stones, preventing their recurrence. The body adapts well to not having a gallbladder, with bile flowing directly from the liver to the small intestine.