Biliary lithiasis or gallstone disease is characterised by the presence of stones in the gallbladder, the biliary ducts, or both.24,25
Stones are accepted to measure >3 mm; smaller concretions are typically considered to form biliary sludge. Gallstone disease may be asymptomatic or associated with chronic or acute symptoms.24,25
Cholelithiasis in the first years of life has been found to be associated with malformations, and pharmacologic or iatrogenic predisposing factors. Early life cases may include asymptomatic cases with spontaneous resolution or more serious cases. Conversely, biliary lithiasis in later childhood and adolescence tends to be clinically similar to cholelithiasis in adults.26
Gallstones are not as common in children as they are in adults, but they do occur from time to time, usually without an obvious underlying cause.27 Risk factors for gallstones in children include:27
- Inherited haematological conditions, such as sickle cell disease or spherocytosis
- Obesity
- A family history of gallstones
- Drugs
- Genetic disorders
Gallstones can be classified according to composition into cholesterol stones and pigment stones. Pigment stones are mainly composed of calcium salts of unconjugated bilirubin and are divided into hard black and soft brown stones. 75% of gallstones in children are pigment stones.28
Diagnosis
- Symptoms: often non-specific such as dyspepsia or chronic abdominal pain28
- Transabdominal ultrasound examination of the gallbladder permits the visualisation of particles in bile, usually those of >2-3mm in diameter.25
- Provides information about stone size, burden and mobility
- Provides information about the gallbladder, including gallbladder size, wall thickness (Wall thickness greater than 3 mm is a sign of cholecystitis29,30),
- Provides information about the intra- and extra-hepatic bile ducts
- Provides information about the liver parenchyma and pancreas29, 30
24. Sauerland S. Epidemiology of biliary lithiasis. Biliary Lithiasis. Milano: Springer; 2008:13-8.
25. Jüngst C, Kullak-Ublick GA, Jüngst D. Gallstone disease: Microlithiasis and sludge. Best Pract Res Clin Gastroenterol 2006;20:1053-62.
26. Agnifili A, Gola P, Marino M, et al. [Biliary lithiasis in childhood. A spectrum of diseases with different clinical significance during fetal life, childhood and adolescence]. Minerva Pediatr 1998;50:127-36.
27. Gallstones. Seattle Children’s Hospital, 2020. (Accessed April, 2020, at https://www.seattlechildrens.org/conditions/gallstones/.)
28. Escobar Castro H, García Novo MD, Olivares P. [Biliary lithiasis in childhood: therapeutic approaches]. An Pediatr (Barc) 2004;60:170-4.
29. Lermite E, Pessaux P. Diagnostic flow charts for biliary lithiasis. Biliary Lithiasis. Milano: Springer; 2008:143-8.
30. Leopold GR, Amberg J, Gosink BB, Mittelstaedt C. Gray scale ultrasonic cholecystography: a comparison with conventional radiographic techniques. Radiology 1976;121:445-8.
