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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
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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
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Copyright
© Cambridge University Press 2016 

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