Hostname: page-component-8448b6f56d-c4f8m Total loading time: 0 Render date: 2024-04-19T23:45:21.506Z Has data issue: false hasContentIssue false
  • English
  • Français

Cholelithiasis in children with CHD: is it a problem?

Published online by Cambridge University Press:  20 June 2016

Simon Kargl ,
Roland Gitter  and
Wolfgang Pumberger
Simon Kargl*
Affiliation:
Department of Pediatric Surgery, Kepler University Hospital, Linz, Austria
Roland Gitter
Affiliation:
Department of Pediatric Cardiology, Kepler University Hospital, Linz, Austria
Wolfgang Pumberger
Affiliation:
Department of Pediatric Surgery, Kepler University Hospital, Linz, Austria
*
Correspondence to: Dr S. Kargl, Department of Pediatric Surgery, Kepler University Hospital Linz, Krankenhausstrasse 26-30, 4020 Linz, Austria. Tel: +43 505546323305; Fax: +43 505546326824; E-mail: simon.kargl@gespag.at
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

An association of heart disease and its treatment with biliary calculi is popularly accepted. We sought determine the prevalence and risk factors of paediatric gallstone disease in the presence of CHD and analyse the treatment options. We evaluated the role of open-heart surgery in the development of gallstones in patients with CHD.

Patients and methods

In a 10-year, retrospective, chart review (2005–2014), patients with CHD and cholelithiasis were identified and reviewed.

Results

In all, 19 of 4729 children with CHD had cholelithiasis (0.4%); eight patients underwent cardiac surgery before diagnosis of cholelithiasis (group 1), whereas 11 of them had not (group 2). The prevalence was 0.3% in group 1 and 0.5% in group 2.

In nine asymptomatic patients, gallstones were found incidentally. Children with cholecystolithiasis (n=17) received ursodeoxycholic acid. A resolution of gallstones was found in four cases; two patients underwent biliary surgery, and the others (15/17) were successfully managed non-operatively.

Conclusion

Despite an accumulation of risk factors, prevalence of gallstones is not as high as expected in children with CHD. Open-heart surgery with a heart–lung machine plays a minor role as an aetiological factor. In about half of the cases, cholelithiasis is an incidental finding and patients stay asymptomatic. Prophylactic administration of ursodeoxycholic acid is not indicated in children undergoing open-heart surgery for CHDs. Biliary surgery is reserved for patients with recurrent symptoms or cholestasis.

In children with CHD, cholelithiasis is a minor and manageable co-morbid condition.

Keywords

CHDcholelithiasischildren
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 4 , May 2017 , pp. 630 - 633
Check for updates
Copyright
© Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Bogue, CO, Murphy, AJ, Gerstle, JT, et.al. Risk factors, complications, and outcomes of gallstones in children: a single-center review. J Pediatr Gastroenterol Nutr 2010; 50: 303–308.CrossRefGoogle ScholarPubMed
2. Svensson, J, Makin, E. Gallstone disease in children. Semin Pediatr Surg 2012; 21: 255–265.CrossRefGoogle ScholarPubMed
3. Wesdorp, I, Bosman, D, de Graaff, A, et al. Clinical presentations and predisposing factors of cholelithiasis and sludge in children. J Pediatr Gastroenterol Nutr 2000; 31: 411–417.Google ScholarPubMed
4. Shiina, Y, Toyoda, T, Kawasoe, Y, et al. The prevalence and risk factors for cholelithiasis and asymptomatic gallstones in adults with congenital heart disease. Int J Cardiol 2011; 152: 171–176.CrossRefGoogle ScholarPubMed
5. Williams, HJ, Johnson, KW. Cholelithiasis: a complication of cardiac valve surgery in children. Pediatr Radiol 1984; 14: 146–147.CrossRefGoogle ScholarPubMed
6. Azemoto, R, Tsuchiya, Y, Ai, T, et al. Does gallstone formation after open cardiac surgery result only from latent hemolysis by replaced valves? Am J Gastroenterol 1996; 91: 2185–2189.Google ScholarPubMed
7. Jeanty, C, Derderian, SC, Courtier, J, et al. Clinical management of infantile cholelithiasis. J Pediatr Surg 2014; 50: 1289–1292.CrossRefGoogle ScholarPubMed
8. Gilger, MA. Cholelithiasis and cholecystitis. In: Wyllie R, Hyams JS, (eds). Pediatric Gastrointestinal Disease. W.B. Saunders Co., Philadelphia, 1993: 931–940.Google Scholar
9. Randall, LH, Shaddy, RE, Sturtevant, JE, et al. Cholelithiasis in infants receiving furosemide: a prospective study of the incidence and one-year follow-up. J Perinatol 1992; 12: 107–111.Google ScholarPubMed
10. Sakopoulos, AG, Gundry, S, Razzouk, AJ, et al. Cholelithiasis in infant and pediatric heart transplant patients. Pediatr Transplant 2002; 6: 231–234.CrossRefGoogle ScholarPubMed
11. Weinstein, S, Lipsitz, EC, Addonizio, L, et al. Cholelithiasis in pediatric cardiac transplant patients on cyclosporine. J Pediatr Surg 1995; 30: 61–64.CrossRefGoogle ScholarPubMed
12. Taşdemir, HA, Cetinkaya, MC, Polat, C, et al. Gallbladder motility in children with Down syndrome. J Pediatr Gastroenterol Nutr 2004; 39: 187–191.CrossRefGoogle ScholarPubMed
13. Toscano, E, Trivellini, V, Andria, G. Cholelithiasis in Down’s syndrome. Arch Dis Child 2001; 85: 242–243.CrossRefGoogle ScholarPubMed
14. Palasciano, G, Portincasa, P, Vinciguerra, V, et al. Gallstone prevalence and gallbladder volume in children and adolescents: an epidemiological ultrasonographic survey and relationship to body mass index. Am J Gastroenterol 1989; 84: 1378–1382.Google ScholarPubMed
15. Charokopos, N, Antonitsis, P, Spanos, C, et al. Concomitant cholecystectomy and open heart surgery. Surg Today 2007; 37: 638–641.CrossRefGoogle ScholarPubMed
16. Baum, VC, Barton, DM, Gutgesell, HP. Influence of congenital heart disease on mortality after noncardiac surgery in hospitalized children. Pediatrics 2000; 105: 332–335.CrossRefGoogle ScholarPubMed
17. Torres, A Jr, DiLiberti, J, Pearl, RH, et al. Noncardiac surgery in children with hypoplastic left heart syndrome. J Pediatr Surg 2002; 37: 1399–1403.CrossRefGoogle ScholarPubMed
18. Miltenburg, DM, Schaffer, R 3rd, Breslin, T, et al. Changing indications for pediatric cholecystectomy. Pediatrics 2000; 105: 1250–1253.CrossRefGoogle ScholarPubMed
19. Klar, A, Branski, D, Akerman, Y, et al. Sludge ball, pseudolithiasis, cholelithiasis and choledocholithiasis from intrauterine life to 2 years: a 13-year follow-up. J Pediatr Gastroenterol Nutr 2005; 40: 477–480.CrossRefGoogle Scholar
20. Della Corte, C, Falchetti, D, Nebbia, G, et al. Management of cholelithiasis in Italian children: a national multicenter study. World J Gastroenterol 2008; 14: 1383–1388.CrossRefGoogle ScholarPubMed
21. Gamba, PG, Zancan, L, Midrio, P, et al. Is there a place for medical treatment in children with gallstones? J Pediatr Surg 1997; 32: 476–478.CrossRefGoogle Scholar
22. Ai, T, Azemoto, R, Saisho, H. Prevention of gallstones by ursodeoxycholic acid after cardiac surgery. J Gastroenterol 2003; 38: 1071–1076.CrossRefGoogle ScholarPubMed