Chronic cholecystitis in the pediatric population: an underappreciated disease process

Brian P Blackwood, Julia Grabowski



Aim: We hypothesize that chronic cholecystitis accounts for the majority of inflammatory diseases in the pediatric population and it is difficult to predict with preoperative ultrasound.

Background: Despite the increase in gallbladder disease, there is a paucity of data on pediatric cholecystitis.  Most pediatric studies focus on cholelithiasis and biliary dyskinesia rather than inflammatory gallbladder disease.

Methods: We performed a single center retrospective review of all patients who underwent cholecystectomy from 1/1/10 – 1/1/15. Relevant data was extracted, including age, sex, acute vs. chronic presentation, duration of symptoms, preoperative imaging findings, and surgical pathology results.

Results: Out of the 170 patients identified, there were 129 (75.9%) females and 41 (24.1%) males. The average age was 14 years (range 4-23 years). Seventy-six patients presented with acute symptoms with an average duration of pain of 2 days. Ninety-four patients presented with chronic symptoms and had an average duration of pain of 7.4 months. Eight patients (4.7%) had preoperative ultrasound that suggested inflammation, while the remaining showed only cholelithiasis. Pathology revealed chronic cholecystitis in 148 (87.1%). Among those who had pathologic evidence of chronic cholecystitis, preoperative inflammation was seen in only 5 patients (3.3%).

Conclusion: Chronic cholecystitis accounts for the majority of pediatric inflammatory diseases. These data suggest that most pediatric patients experience episodes of inflammation prior to cholecystectomy. Underappreciated gallbladder inflammation may delay surgical referral, increase emergency department and primary doctor visits, and lead to more difficult operations. Surgeons should consider early cholecystectomy when cholelithiasis and symptoms are present.


Pediatric, Cholecystitis, Diagnosis, Intervention, Timing

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Mehta S, Lopez ME, Chumpitazi BP et al. Clinical characteristics and risk factors for symptomatic pediatric gallbladder disease. Pediatrics 2012; 129: e82-88

Silva IV, Reis AF, Palare MJ et al. Sickle cell disease in children: chronic complications and search of predictive factors for adverse outcomes. European journal of haematology 2015; 94: 157-161

Srinath A, Saps M, Bielefeldt K. Biliary dyskinesia in pediatrics. Pediatric annals 2014; 43: e83-88

Srinath AI, Youk AO, Bielefeldt K. Biliary dyskinesia and symptomatic gallstone disease in children: two sides of the same coin? Digestive diseases and sciences 2014; 59: 1307-1315

Soper NJ. Cholecystectomy: from Langenbuch to natural orifice transluminal endoscopic surgery. World journal of surgery 2011; 35: 1422-1427

Tucker JJ, Grim R, Bell T et al. Changing demographics in laparoscopic cholecystectomy performed in the United States: hospitalizations from 1998 to 2010. The American surgeon 2014; 80: 652-658

Svensson J, Makin E. Gallstone disease in children. Seminars in pediatric surgery 2012; 21: 255-265

Walker SK, Maki AC, Cannon RM et al. Etiology and incidence of pediatric gallbladder disease. Surgery 2013; 154: 927-931; discussion 931-923

Fradin K, Racine AD, Belamarich PF. Obesity and symptomatic cholelithiasis in childhood: epidemiologic and case-control evidence for a strong relation. Journal of pediatric gastroenterology and nutrition 2014; 58: 102-106

Bonfrate L, Wang DQ, Garruti G et al. Obesity and the risk and prognosis of gallstone disease and pancreatitis. Best practice & research Clinical gastroenterology 2014; 28: 623-635

Constantinescu T, Huwood Al Jabouri AK, Bratucu E et al. Gallstone disease in young population: incidence, complications, therapeutic approach. Chirurgia 2012; 107: 579-582

Friedman GD, Kannel WB, Dawber TR. The epidemiology of gallbladder disease: observations in the Framingham Study. Journal of chronic diseases 1966; 19: 273-292

Maclure KM, Hayes KC, Colditz GA et al. Weight, diet, and the risk of symptomatic gallstones in middle-aged women. The New England journal of medicine 1989; 321: 563-569

Cao AM, Eslick GD, Cox MR. Early laparoscopic cholecystectomy is superior to delayed acute cholecystitis: a meta-analysis of case-control studies. Surgical endoscopy 2015; DOI: 10.1007/s00464-015-4325-4:

Gurusamy KS, Davidson C, Gluud C et al. Early versus delayed laparoscopic cholecystectomy for people with acute cholecystitis. The Cochrane database of systematic reviews 2013; 6: CD005440

Low JK, Barrow P, Owera A et al. Timing of laparoscopic cholecystectomy for acute cholecystitis: evidence to support a proposal for an early interval surgery. The American surgeon 2007; 73: 1188-1192

Menahem B, Mulliri A, Fohlen A et al. Delayed laparoscopic cholecystectomy increases the total hospital stay compared to an early laparoscopic cholecystectomy after acute cholecystitis: an updated meta-analysis of randomized controlled trials. HPB : the official journal of the International Hepato Pancreato Biliary Association 2015; DOI: 10.1111/hpb.12449:

Zafar SN, Obirieze A, Adesibikan B et al. Optimal time for early laparoscopic cholecystectomy for acute cholecystitis. JAMA surgery 2015; 150: 129-136

Banz V, Gsponer T, Candinas D et al. Population-based analysis of 4113 patients with acute cholecystitis: defining the optimal time-point for laparoscopic cholecystectomy. Annals of surgery 2011; 254: 964-970

Schwartz DA, Shah AA, Zogg CK et al. Operative delay to laparoscopic cholecystectomy: Racking up the cost of health care. The journal of trauma and acute care surgery 2015; 79: 15-21

Heames R, du Boulay C. A clinicopathological survey of gallstones in the autopsy population. J R Nav Med Serv 1993; 79: 83-87

Raptopoulos V, Compton CC, Doherty P et al. Chronic acalculous gallbladder disease: multiimaging evaluation with clinical-pathologic correlation. AJR Am J Roentgenol 1986; 147: 721-724

Smith EA, Dillman JR, Elsayes KM et al. Cross-sectional imaging of acute and chronic gallbladder inflammatory disease. AJR Am J Roentgenol 2009; 192: 188-196

Tsai J, Sulkowski JP, Cooper JN et al. Sensitivity and predictive value of ultrasound in pediatric cholecystitis. The Journal of surgical research 2013; 184: 378-382

Lugo-Vicente HL. Gallbladder dyskinesia in children. JSLS 1997; 1: 61-64

Goetze TO. Gallbladder carcinoma: Prognostic factors and therapeutic options. World J Gastroenterol 2015; 21: 12211-12217

Fink-Bennett D, Freitas JE, Ripley SD et al. The sensitivity of hepatobiliary imaging and real-time ultrasonography in the detection of acute cholecystitis. Archives of surgery 1985; 120: 904-906

Park MS, Yu JS, Kim YH et al. Acute cholecystitis: comparison of MR cholangiography and US. Radiology 1998; 209: 781-785

Shea JA, Berlin JA, Escarce JJ et al. Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease. Archives of internal medicine 1994; 154: 2573-2581

Ulreich S, Foster KW, Stier SA et al. Acute cholecystitis. Comparison of ultrasound and intravenous cholangiography. Archives of surgery 1980; 115: 158-160


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PISSN: 2008-2258

EISSN: 2008-4234


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