Síntomas prevalentes y factores de riesgo de litiasis biliar en pacientes pediátricos en un hospital de referencia

Susana Florentina Sánchez; Nair Raquel Bogado; Mabel Sofía Zacur

doi:10.18004/anales/2020.053.03.25

Authors

Susana Florentina Sánchez Universidad Nacional de Asunción, Facultad de Ciencias Médicas, Cátedra y Servicio de Pediatría. San Lorenzo https://orcid.org/0000-0001-7156-1452
Nair Raquel Bogado Universidad Nacional de Asunción, Facultad de Ciencias Médicas, Cátedra y Servicio de Pediatría. San Lorenzo https://orcid.org/0000-0002-6140-4565
Mabel Sofía Zacur 1Universidad Nacional de Asunción, Facultad de Ciencias Médicas, Cátedra y Servicio de Pediatría. San Lorenzo https://orcid.org/0000-0002-0474-1063

DOI:

https://doi.org/10.18004/anales/2020.053.03.25

Keywords:

gallstones, cholelithiasis, children, pediatrics, Paraguay

Abstract

Introduction: Gallstones are considered infrequent in childhood; however, 50% of young adults with gallbladder disease had their first symptoms during this period. There are few studies in the pediatric population about this pathology in Paraguay. Objectives: To determine the prevalent symptoms and the presence of predisposing factors in children and adolescents with gallstones at a referral hospital. Materials and methods: it is a cross-sectional, retrospective, descriptive, observational study; based on clinical records of patients hospitalized between January 2014 and January 2019, non-probabilistic sampling of consecutive cases of patients who meet the inclusion criteria. Results: 58 patients with the diagnosis of gallstones were found, of which 3 (5.2%) were preschool children, 9 (15.5%) children and 46 (79.3%) adolescents. There was a predominance of females 67.2% (39/58) over males 33% (19/58). As for clinical manifestations, 57 patients (98%) reported abdominal pain, 30 (51%) vomiting and a lesser extent coursed with jaundice, dark urine or hypocolia. Regarding the nutritional profile, 1 patient (8,6%) presented malnutrition and 29 (50%) were overweight or obese. In relation to height, 5 (8.6%) were short stature. Only 4 patients (6.8%) had a family history of gallstones. None of them had complications or were associated to parenteral nutrition. 2 patients had received broad spectrum antibiotics. Conclusion: Gallstones occurred mainly in female adolescents. In most cases was idiopathic and, abdominal pain was the most frequent symptom.

References

1. Evers BM, Mattox KL, Townsend CM, Beauchamp RD. Sabiston. Cirugía general y del aparato digestivo. Vol. 19a. edición. Barcelona, España: Elsevier; 2014

2. Machain G, Yamanaka W, López G, Martinez M, Gonzalez M. Prevalencia de litiasis biliar en personas concurrentes al hospital de clínicas. Rev. Cir. Parag. 2017; 41(2): 21-24.

3. Rescorla F. Cholelithiasis, cholecystitis and common bile duct stones. Curr Opin Pediatr 1997; 9: 276-82.

4. Palasciano G, Portincasa P, Vinciguerra V, Velardi A, Tardi S, Baldassarre G, 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

5. Kratzer W, Mason RA, Kächele V. Prevalence of gallstones in sonographic surveys worldwide. J Clin Ultrasound. 1999;27:1–7

6. Kratzer, W., Walcher, T., Arnold, F., Akinli, A., Mason, R., Denzer, C., Hänle, M.. Gallstone Prevalence and Risk Factors for Gallstone Disease in an Urban Population of Children and Adolescents. Zeitschrift Für Gastroenterologie, (2010 48(06), 683–687.

7. Wesdorp I, Bosman D, de Graaff A, Aronson D, van der Blij F, Taminiau J. Clinical presentations and predisposing factors of cholelithiasis and sludge in children. J Pediatr Gastroenterol Nutr. 2000;31:411-7.

8. Harris P, Chateau B, Miquel J. Litiasis biliar pediátrica en una población de alta prevalencia. Rev Chil Pediatr. 2007;78(5):511-8.

9. Nilsson S, et al. Gallbladder disease and sex hormones. Acta Chir Scand. 1966;132: 275-279.

10. Kaechele V, Wabitsch M, Thiere D, Kessler A, Haenle M, Mayer H, Kratzer W. Prevalence of gallbladder stone disease in obese children and adolescents: influence of the degree of obesity, sex, and pubertal development. J Pediatr Gastroenterol Nutr 2006; 42:66-70.

11. Vialat V, Olivera R, Vázquez E, López V. Litiasis biliar en el niño, diez años de experiencia. Revista Cubana de Pediatría. 2015;87(1):21–30

12. Espinosa D, Flores J, González B, Rodríguez P. Características de pacientes pediátricos con litiasis biliar. Revista Medica del IMSS. 2014;52:S54–7.

13. Siddiqui S, Newbrough S, Alterman D, Anderson A, Kennedy A. Efficacy of laparoscopic cholecystectomy in the pediatric population. J Ped Surgery 2008; 43:109-113.

14. Gupta S, Gupta V. Cholecystitis and cholelithiasis in children. Indian J Pediatr. 1991;28(7):801-3

15. World Health Organization. Anthro (versión 3.2.2, enero de 2011).

16. Adoptada por la 18a Asamblea Médica Mundial, Helsinki, Finlandia, Junio 1964 y enmendada por la 29a Asamblea Médica Mundial, Tokio, Japón, Octubre 1975, 35a Asamblea Médica Mundial, Venecia, Italia, Octubre 1983, 41a Asamblea Médica Mundial, Hong Kong, Septiembre 1989, 48ª Asamblea General, Somerset West, Sudáfrica, Octubre 1996 y la 52a Asamblea General, Edimburgo, Escocia, Octubre 2000.

17. Punia RPS. Clinico-pathological spectrum of gallbladder disease in children. Acta Pediátrica. 2010;99:1561-4

18. Machain G, Yamanaka W, López G, Martinez M, Gonzalez M. Prevalencia de litiasis biliar en personas concurrentes al hospital de clínicas. Rev. Cir. Parag. 2017; 41(2): 21-24.

19. Arellano P, Perea C, De La Garza H, Hernández N, et al. Prevalencia y factores de riesgo de colelitiasis de pacientes menores de 18 años en un hospital de segundo nivel. Cirujano general Rev.2012; 4: 267-270.

20. Koebnick, C., Smith, N., Black, M. H., Porter, A. H., Richie, B. A., Hudson, S., … Longstreth, G. F. (2012). Pediatric Obesity and Gallstone Disease. Journal of Pediatric Gastroenterology and Nutrition, 55(3), 328–333.

21. Fradin K, Racine A, Belamarich P. Obesity and Symptomatic Cholelithiasis in Childhood: Epidemiologic and Case Control Evidence for a strong relation. J Pediatr Gastroenterol Nutr 2014;58:102-106.

22. Frybova B, Drabek J, Lochmannova J, et al. Cholelithiasis and choledocholithiasis in children; risk factors for development. PLoS One. 2018; 13(5): e0196475.

23. Peláez F. Gastroenterología y hepatología. 5ª edición. Vol. nº2. Enfermedad de la vesícula y de las vías biliares.Colombia: Editorial CIB; 2007. 248-259.

24. Bogue, C. O., Murphy, A. J., Gerstle, J. T., Moineddin, R., & Daneman, A. (2010). Risk Factors, Complications, and Outcomes of Gallstones in Children: A Single-center Review. Journal of Pediatric Gastroenterology and Nutrition, 50(3), 303–308.

25. Poddar, U. (2010). Gallstone disease in children. Indian Pediatrics, 47(11), 945–953. doi:10.1007/s13312-010-0159-2