Acute cholecystitis in children

Acute cholecystitis in children is an acute inflammation of the gallbladder.

ICD-10 code

K81.0. Acute cholecystitis.

Epidemiology of acute cholecystitis

There are no data on the ratio of the frequency of acute cholecystitis and other diseases of the biliary tract in childhood, although acute cholecystitis may be the reason for hospitalization of patients with a picture of acute abdomen. In the overwhelming majority of cases (90-95%), acute cholecystitis is the most common complication of cholelithiasis, only in 5-10% it develops without stones in the gallbladder.

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Causes of acute cholecystitis in children

The leading role in the development of acute cholecystitis in children belongs to infection (E. coli, staphylococcus, streptococcus, proteus, enterococcus, typhoid bacillus). The pathogenetic role of enzymes and proenzymes of the pancreas entering the bile ducts and gall bladder and provoking acute enzymatic cholecystitis is studied.

What causes acute cholecystitis?

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Pathomorphology

Catarrhal cholecystitis is an inflammation limited to the mucous and submucous membranes, characterized by swelling and thickening of the gallbladder wall, an increase in its size. The mucous membrane is hyperemic, infiltrated with cellular elements, and has areas of hemorrhage. As acute inflammatory changes are eliminated, fibrosis occurs. In the case of fibrin deposition, adhesions are formed, causing deformation of the organ. When the cystic duct is blocked (by scars, stones), dropsy of the gallbladder develops, often occurring latently.

In phlegmonous cholecystitis, purulent inflammation with infiltration affects all layers of the thickened wall of the gallbladder. The organ is enlarged, covered with fibrin on the outside, the mucous membrane is sharply hyperemic or reddish-brown, covered with fibrin, necrotic in places with single or multiple ulcers. Abscesses may form in the wall of the gallbladder, breaking through into the bladder or its bed. The bladder may contain bile, inflammatory exudate, and pus. In the case of obliteration of the cystic duct, empyema of the gallbladder develops.

Gangrenous cholecystitis is characterized by pronounced morphological changes in the gallbladder, resulting from significant blood supply disorders, including vascular thrombosis. Gangrene affects the mucous membrane of the organ, can be focal, and in rare cases the entire bladder dies; perforation leads to the release of infected contents into the abdominal cavity.

The inflammatory process can be progressive or frozen at any stage of inflammation. In children, the most common form of gallbladder damage is catarrhal cholecystitis.

Symptoms of acute cholecystitis in children

The disease begins acutely, suddenly, often at night with severe pain in the right hypochondrium, epigastric region, less often in other areas of the abdomen (in preschool children). The child is extremely restless, tossing and turning in bed, trying to find a position that alleviates the pain. Nausea and vomiting with bile occur, often multiple and not bringing relief.

In preschool (up to 7 years) and primary school children (8-11 years), abdominal pain can be diffuse or vague, which creates diagnostic difficulties and provokes medical errors. In adolescent patients (12-13 years), the pain is pronounced, sharp, "dagger-like" in nature and begins to localize in the right hypochondrium. Irradiation of such pain to the right shoulder, shoulder blade, right half of the lower back and iliac region is noted.

Symptoms of acute cholecystitis

Classification of acute cholecystitis

Depending on the nature of the pathomorphological changes in the gallbladder, the following forms of acute primary inflammation are distinguished: catarrhal, phlegmonous, gangrenous.

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How to recognize acute cholecystitis in children?

The anamnesis data are usually uninformative, the disease develops suddenly. When examining a sick child, a forced position and yellowness of the skin are determined. The area of maximum abdominal pain (right hypochondrium), the size of the liver and spleen are determined by palpation.

Diagnosis of acute cholecystitis

Treatment of acute cholecystitis in children

Children with acute cholecystitis are urgently hospitalized. Strict bed rest is prescribed, and observation by a pediatrician, pediatric surgeon, and other specialists is required to determine the treatment tactics.

Fasting is indicated. While preschool (up to 7 years) and school-age children with catarrhal acute cholecystitis can go without food for a certain period of time, an individual approach is required for young patients (up to 3 years). Parenteral nutrition is not excluded.

How is acute cholecystitis treated?

Forecast

With early diagnosis and targeted treatment, the prognosis for the catarrhal form of acute cholecystitis is quite favorable. In the case of phlegmonous and gangrenous forms of acute cholecystitis, the outcome of the disease is not always predictable.

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