Gallstones or cholelithiasis are pebble-like, solid deposits formed by the solidification of digestive fluids in the gallbladder (1). The complex interplay of environmental and genetic factors causes gallstones in children. Children with a positive family history and certain inherited disorders are more likely to develop gallstones. Childhood obesity and certain medications may also increase the risk. Gallstones are painless and asymptomatic in most cases. However, inflammation and pain may occur if the stone blocks the flow of digestive juices, such as from the pancreas (2). Read on to know about possible causes, symptoms, risk factors, treatment, and prevention of gallstones in children.
What Causes Gallstones In Children?
Gallstones form in the gallbladder, a small, sac-like organ present below the liver. The gallbladder stores bile (a digestive juice produced by the liver) and releases it into the duodenum (part of the small intestine) after meals to aid digestion. However, this process doesn’t work smoothly in some cases, leading to gallstones’ development due to the following reasons (1) (3).
Cholesterol supersaturation: The liver excretes cholesterol, which it dissolves into bile. However, if cholesterol excretion increases, the bile may contain a concentrated amount of dissolved cholesterol. The excess cholesterol precipitates, leading to the formation of cholesterol crystals. These crystals gradually fuse into yellowish-green cholesterol gallstones over time.
Excess bilirubin: Bilirubin is a yellow-colored by-product of red blood cells (RBCs) breakdown, which occurs inside the liver. The liver recycles bilirubin by using it as an ingredient in bile. However, certain blood disorders could concentrate the amount of bilirubin in bile. The high amount of bilirubin could eventually lead to the formation of gallstones. These are known as pigment gallstones, which are the most common type of gallstones found in children.
Gallbladder hypomotility: The gallbladder may sometimes not empty adequately. It could cause bile stagnation, which may lead to gallstones formation over time. Insufficient bile salts within the gallbladder could also lead to gallstones’ development.
An individual can have cholesterol or bilirubin stones or a mix of both types. Gallstones can be as tiny as a sand grain or as big as a golf ball (4).
What Are The Risk Factors For Gallstones In Children?
In most pediatric cases, there’s no definitive cause for gallstone formation. Some factors may put a child at a higher risk of gallstone development (5) (6). Certain health conditions, such as Crohn’s disease and inflammatory bowel disease, some medications, abdominal surgery, and prolonged intravenous feeding, may also increase the risk of gallstones in children and teens.
What Are The Symptoms Of Gallstones In Children?
Gallstones may not always cause symptoms. If gallstones block the cystic duct, it can cause an accumulation of bile within the gallbladder. This condition is known as a gallbladder attack or biliary colic, which could lead to the following symptoms (1) (3) (14). These symptoms may come and go when the gallstones move and the cystic duct unblocks. However, if the gallstones obstruct the bile flow for more than a few hours or move into other organs, such as the pancreas, it may cause complications with the following symptoms (4).
High-grade fever, i.e., 38°C (100.4°F) or above
Yellowing of the skin and whites of the eyes (jaundice)
Diarrhea or light-colored stools and tea-colored urine
Intense shivering and chills
Rapid heartbeat
Gallstone symptoms are similar to those that occur in other gastrointestinal problems. Therefore, consult a pediatrician to determine the underlying cause.
How Are Gallstones Diagnosed In Children?
A doctor will note the child’s family, medical, and diet history. Based on their evaluation, they may refer you to a gastroenterologist who would do the following tests (16) (17). Based on the diagnosis, the doctor will prescribe a suitable treatment plan for the child.
How Are Gallstones Treated?
Asymptomatic or silent gallstones usually do not require any treatment. Painful and symptomatic gallstones could be treated with the following treatment methods (17) (18).
1. Nonsurgical methods
A doctor may use nonsurgical methods to eliminate cholesterol gallstones. Some of these methods are:
Oral dissolution therapy uses medicines to breakdown, dissolve, and remove the stones. Medicines, such as ursodiol (actigall) and chenodiol (chenix), containing bile acids, are used for the treatment. These medicines are slow-acting and may take several months or years to work.
Lithotripsy uses shock waves to break gallstones into smaller pieces. This treatment method is used rarely and often with oral dissolution therapy.
Although these treatment modalities remove stones, they can’t prevent a recurrence. Regular treatment and observation might be needed in some cases.
2. Surgical methods
Surgical methods could be considered for the removal of gallstones. If a child experiences severe symptoms or other treatment methods do not provide sustained relief, surgical removal of the gallbladder (cholecystectomy) is the only alternative treatment. Below are the surgical techniques that a doctor may consider.
Endoscopic retrograde cholangiopancreatography (ERCP): The doctor puts an endoscope with tiny lights and a camera into the upper digestive system through the mouth to locate and remove gallstones. The doctor may use additional instruments to address any blockage or infection. It is a preferred procedure for pediatric patients since it involves a shorter stay at the hospital.
Laparoscopic cholecystectomy: Laparoscopic surgery or keyhole surgery is a minimally invasive technique to remove the gallbladder. In this method, a few small holes are made into the abdomen to insert a camera and surgical instruments. The gallbladder is then removed through the holes. It is the preferred method of removing the gallbladder in children since it causes less pain and involves shorter hospitalization time.
Open cholecystectomy: Severe gallbladder inflammation, infection, or gallstones accompanied by the unusual anatomy of the common bile duct, may require open cholecystectomy. The procedure involves a large incision on the abdominal cavity for the removal of the gallbladder. The child may have to stay a few days to up to a week after the procedure.
The course of treatment would depend on the intensity of pain and the size of the gallstones. The doctor may recommend dietary changes, such as avoiding fatty foods, along with treatment. Once the gallbladder is removed, the bile will directly flow from the liver to the duodenum. A child may observe minor changes, such as soft or loose stools for a short time. However, it usually does not cause any long-term side effects.
What Are The Possible Complications Of Gallstones?
If gallstone symptoms are left unattended, they may lead to a series of complications, such as (1) (19): Gallstones could rarely cause gallbladder cancer. A family history of gallstones and high levels of calcium in the gallbladder could increase the risk. The complications of gallstones tend to be uncommon since children are likely to report symptoms, such as pain and discomfort, much before the development of complications.
Can You Prevent Gallstones In Children?
There is no definite method to prevent gallstones. Parents could lower their child’s risk of developing gallstones by mitigating the risk factors through the following steps (20).
