Let me answer the question in the title right away: Yes, your child could have gallstones.
In The Pediatric Surgeon’s Journal, I’d like to discuss gallstones in children with you. Let’s begin.
We know that gallbladder disease is one of the most common digestive system disorders in adults. While less common in children, it should be considered, especially if there is pain in the upper right side of the abdomen. There are small differences between adults and children when it comes to gallstones.
Let me explain. In adults, the most common type of gallstones are cholesterol stones. These form when cholesterol combines with bile, bilirubin, proteins, and carbonates to solidify. However, in children, cholesterol stones are only the third most common type. In children, the most frequent type of gallstones are black pigment stones, which occur due to the mixing of bile with certain calcium salts. This is often seen in association with specific blood disorders or after intravenous feeding.
The second most common type in children is calcium carbonate stones, which are very rare in adults.
In children, the presence of gallstones usually indicates an underlying condition. These could include blood disorders, liver or bile duct problems, obesity, prolonged intravenous feeding, abdominal surgery, trauma, removal of parts of the small intestine, Crohn’s disease, sepsis, or even pregnancy. Less commonly, gallstones may also result from acute kidney failure, prolonged fasting, low-calorie diets, or rapid weight loss. Additionally, certain antibiotics and genetic disorders can be contributing factors.
Because of these underlying causes, gallstones can occur in children, and their prevalence is gradually increasing. Although the exact rate is unknown, it is estimated to be around 1-2%. This is partly due to more frequent use of ultrasonography and the growing problem of childhood obesity. In certain blood disorders like sickle cell anemia, the risk is much higher. Nearly half of children with this condition develop gallstones by the age of 20. In fact, 20-40% of gallstones in children are associated with blood disorders.
Before puberty, gallstones are equally common in boys and girls, but after puberty, they are more common in girls.
The complications caused by gallstones in children are not much different from those in adults. While 80% of gallstones in adults are asymptomatic, this figure drops to 40% in children. Even so, gallstones may remain asymptomatic for about 10 years. Over time, they can lead to chronic abdominal pain, nausea, and vomiting. Smaller stones can sometimes move into the bile duct, causing blockages, inflammation in the gallbladder or bile ducts, pancreatitis, hepatitis, or even intestinal obstructions. Properly timing intervention before these complications arise is crucial.
In cases where there is a blood disorder like sickle cell anemia, surgery to remove the gallbladder (laparoscopic cholecystectomy) is essential. In other cases, asymptomatic gallstones can sometimes regress with regular monitoring. In children, a medication called ursodeoxycholic acid (Ursofalk) can reduce symptoms in about 80% of cases. However, complete regression occurs in only about 7% of cases, and 50% of those experience recurrence. For this reason, medication is generally used only in children who cannot undergo surgery or who refuse surgery. Otherwise, surgery is the most definitive solution.
Gallbladder removal is not a difficult operation. It is typically a laparoscopic procedure, performed with the use of a camera and surgical instruments inserted into the abdomen. Most patients can be discharged within a day. Interestingly, about 4-5% of patients continue to experience abdominal pain even after the gallbladder is removed. Therefore, in children without symptoms or blood disorders, surgery is not the standard treatment. When considering the potential complications of surgery, it is essential to carefully select patients.
Of course, the best scenario is to prevent gallstones altogether. What can be done?
  • Avoid fatty foods.
  • Prevent excessive weight gain and obesity.
  • Encourage regular exercise. It is known that exercise alone can reduce symptomatic gallstones by about 20%.
Let’s conclude this journal entry here. Stay healthy and happy!
Prof. Dr. Egemen Eroğlu
November 2024