The gallbladder is a sac-like organ located under the liver. It ensures the storage and concentration of bile produced in the liver, helps bile digestion and especially the absorption of fats from the intestinal system. Bile stored in the gallbladder is secreted from the gallbladder to the first part of the intestine after eating.
Gallbladder diseases in children, inflammation and infection (cholecystitis), gallstones (cholelithiasis) > or blockage of the bile ducts (obstruction), lack of necessary movements in the gallbladder that ensure bile excretion (biliary dyskinesia), tissues growing into the gallbladder (gallbladder polyps) .
What are the causes of gallbladder diseases?
Gallstones are also seen in children, although they are not as common as in adults. There is usually no obvious cause for gallstones in children. It can be seen in some hereditary blood diseases (such as spherocytosis and sickle cell disease). Other risk factors include obesity, family history, and some medications taken.
Risk Factors:
- Obesity
- Pregnancy
- Sepsis
- Dehydration
- Chronic bile acid malabsorption
- Ileal resection
- TPN (change in bile composition, impairment of enterohepatic circulation of bile salts, bile stasis due to insufficiency of cholecystokinin stimulation)
- Ceftriaxone
- CH
- Cr diarrhea
- Oral contraceptives
- Choledochial cysts
- Furasemide use (in the treatment of congenital heart and lung diseases)
- Vagotomy+ Gastrectomy
- Heart valve replacement
Types of Gallbladder Stones:
1. Cholesterol Stones: They are soft and not very large
- They have a round, smooth surface
- Yellow- They are white in color
- They are usually single
b.Mix cholesterol (Cholesterol+Bilirubin+ Protein+Ca Salts+Fatty acids)
- They are brown
- They are numerous
2.Pigment stones(Unconjugated bilirubin+Ca)
- They are more common in babies and young ages
- They have pointed lines, rough surfaces and are hard
- They are brown and soft
- They are involved in bacterial colonization
3.Calcium carbonate stones
Clinical:
Gallstones do not always cause symptoms (asymptomatic). When they do present, the symptoms begin suddenly. Abdominal pain begins, and over time, abdominal pain becomes localized to the upper right part of the abdomen. It hits the back and pain can be felt in the right shoulder blade. Young children cannot describe the location of the pain very well. Older children show the upper right or middle part of the blood. They describe pain in the back or at the level of the shoulder blade. The pain may be sharp, cramp-like, or more vague. It disappears from time to time and starts again. It may be more severe after fatty meals. If a gallstone blocks a duct, some symptoms may be seen together or alone: nausea, vomiting, fever and jaundice (yellow shiny appearance on the eyes and skin).
Diagnosis:
Gallbladder ha The most commonly used imaging method for stones or stones is ultrasonography. Other tests may be performed to show gallstones and obstruction caused by stones in the bile ducts. Different examinations such as abdominal x-ray, magnetic resonance cholangiopancreatography or endoscopic retrograde pancreatography are valuable in diagnosis and treatment. Blood tests show whether your child has an infection or whether jaundice has developed due to obstruction.
Differential Diagnosis: Other diseases to keep in mind;
- Acute appendicitis
- Hepatitis
- Pancreatitis
- Pyelonephritis
- Sickle cell anemia crisis.
Treatment of gallbladder diseases in children
If gallbladder stones do not cause any symptoms, they can be monitored. In case of symptomatic stones, the gallbladder is surgically removed, this surgery is called cholecystectomy. Cholecystectomy is a very common surgical procedure and patients who undergo cholecystectomy do not have any problems with eating. The child can eat normally. Bile produced in the liver passes directly to the intestines without being stored. Soft stools may be observed for a while, especially after fatty foods.
Surgical Treatment:
Closed (laparoscopic) surgery is usually performed. Instead of a large surgical incision, the surgery is completed with a camera and instruments placed into the abdomen through small incisions. In some cases, it is necessary to perform open surgery or switch from closed surgery to open. Surgery can be performed openly, especially if the patient has previously had intra-abdominal surgery.
If there is a suspicion of stones falling from the gallbladder into the bile ducts, an x-ray of the bile ducts may be required during the surgery. If there is a stone in the bile ducts, this stone must be removed through various procedures. If the child is not young, the stone can be removed or passed endoscopically with endoscopic retrograde-cholangio-pancreatography.
Image 1: Trocar entry sites for laparoscopic cholecystectomy
After surgery:
After laparoscopic surgery, your child can be discharged the next day, 2 to 5 days after open surgery. Pain medication and activity restriction are required . The surgical wound should be kept clean and dry. Your child can take a bath and start school after 1 week.
You should consult a doctor in case of fever over 380C, redness, tenderness, discharge at the wound site, vomiting, loss of appetite, or jaundice.
Picture 2: View of the gallbladder removed after laparoscopic cholecystectomy as a whole and with stones after opening it.
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