|Year : 1987 | Volume
| Issue : 2 | Page : 84-6
Gall stones in a child (a case report).
MN Ahmed, TT Ram, MM Ali, MA Dar, DN Bhat, PA Rashid
M N Ahmed
|How to cite this article:|
Ahmed M N, Ram T T, Ali M M, Dar M A, Bhat D N, Rashid P A. Gall stones in a child (a case report). J Postgrad Med 1987;33:84-6
|How to cite this URL:|
Ahmed M N, Ram T T, Ali M M, Dar M A, Bhat D N, Rashid P A. Gall stones in a child (a case report). J Postgrad Med [serial online] 1987 [cited 2020 Feb 28 ];33:84-6
Available from: http://www.jpgmonline.com/text.asp?1987/33/2/84/5287
The occurrence of cholelithiasis in the paediatric age group is uncommon.,,, To some extent the concept of gall stones as a disease of middle or advanced age still prevails despite a few reports by some authors that gall stone formation may be seen in the early adult life.,, Though gall bladder disease is quite prevalent in Kashmir valley and a few cases of acalculous cholecystitis have been seen below 15 years of age, yet till to date no case of cholelithiasis below 10 years has been reported from our institution. Herein, we wish to report a rare case of cholelithiasis in a 7½ year old child, who needed an emergency cholecystectomy for his ailment. Probably, this might be the first case of its nature from India.
F.A., a 7½ year old, Muslim, male child was referred to the emergency surgical services of the SMHS hospital, on 18th December, 1983, with the chief complaints of severe abdominal colicky pain, vomiting and fever of 3 days' duration. There was also a history of a swelling in the right hypochondrium, noticed only 2 days ago. Patient's attendants gave history of similar complaints, though of very mild intensity, for the past three years for which he used to get antispasmodics. Past history also revealed passing of worms for which he had received vermifuge. The patient had never been investigated or hospitalized. There was no history of enteric fever, jaundice or symptoms suggestive of peptic ulcer disease.
Examination revealed an averagely built, ill looking, toxic child, having a pulse rate of 120 per minute, temperature of 102 °F, and a respiratory rate of 25 per minute. There was no anaemia, cyanosis, jaundice or generalized lymphadenopathy. The abdomen was mildly distended with all quadrants moving with respiration. There was a tender, pyriform swelling, measuring 8.5 cm x 3 cm in the right hypochondrium, moving with respiration. The swelling was smooth and firm in consistency. Rest of the abdomen was soft and there was no organomegaly. There was no free fluid in the peritoneal cavity. Bowel sounds were present. External genitalia were normal. Per rectal examination did not reveal any abnormality. Chest, spine and rest of the systemic examination were normal. A provisional diagnosis of gall bladder disease (empyema gall bladder) was made.
Investigations revealed haemoglobin of 12 gm%, TLC 9200/cumm, with P-70%, L-28% and E-2%. Bleeding time, clotting time and pro-thrombin time were within normal limits and the same was true of urine analysis. Plain skiagram of the abdomen did not show any radio-opaque shadow in the gall bladder area. X-ray of the chest was normal. Blood sugar, serum cholesterol and liver function tests were all within normal limits.
The patient was put on naso-gastric suction half hourly, intravenous fluids and parenteral antibiotics but without any relief what so ever; instead, his condition started deteriorating. He became more toxic, tachycardia increased abdominal tenderness started increasing, lump started becoming diffuse and there was rebound tenderness and guarding after eight hours of conservative line of treatment. Hence a decision was taken to do an exploratory laparotomy.
The abdomen was opened after making an upper right paramedian incision. The stomach, duodenum, pancreas, spleen, liver and rest of the gut were found to be normal.
The gall bladder was distended, inflammed and thickened having a few flimsy adhesions which could be lysed easily. On aspirating the gall bladder, about 70 ml of pus came out and now a stone could be palpated in the Hartmann's pouch. The common bile duct was normal. Over the serosal surface of gall bladder there were a few gangrenous patches mostly towards the fundus and the Hartmann's pouch. An emergency cholecystectomy was performed by fundus first, method. After ensuring complete haemostasis, the gall bladder bed was stiched with catgut and a corrugated drain was put in and brought out through a separate stab incision.
On cutting open the gall bladder, a solitary cholesterol stone, measuring 1.5 cm in diameter, was found. The mucosa of the gall bladder was markedly congested. The drain was removed after 48 hours. The patient had an uneventful post-operative period. Stiches were removed on the 8th post-operative day. The patient was discharged on the 10th day. Since then, the patient is regularly attending our follow-up clinics and is symptom-free.
The histopathological sections of the extirpated gall bladder showed acute inflammation. The chemical analysis of the stone showed it to be a pure cholesterol stone.
Calculi usually develop in the gall bladder itself but their etiology is still uncertain. Fat, fertile females over 40 years of age are the classical victim of the disease. Cholecystitis is also not uncommon in males. 20% of people over the age of 40 years in the developed countries have gall stones. Occurrence of gall stones is equally distributed in both sexes before puberty.
Among the various studies conducted, 51% of the 163 Punjabi patients of less than 40 years of age, had gall bladder disease.2 The youngest patient reported in the above series by Chuttani et al, was 11 year old. Madden et al reported their youngest patient of 17 years.
Out of a total of 100 cases of biliary lithiasis, admitted in various surgical services of our hospital from January 1975 till December 1975, only 3 cases were in the age group of 11-20 years and the youngest patient was 12 years old. Hence the patient reported herein seems to be the youngest one having biliary lithiasis. Moreover, an emergency cholecystectomy had to be performed at such a younger age in this patient.
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