Chronic cholecystitis in children

Chronic cholecystitis in children is an inflammatory-dystrophic disease of the gallbladder with a chronic course and recurrent subacute clinical picture.

ICD-10 code

K81.1. Chronic cholecystitis.

Epidemiology of chronic cholecystitis in children

There are no data on the prevalence of chronic cholecystitis among pediatric patients. In surgical practice, in patients with suspected cholelithiasis, "stone-free" cholecystitis is diagnosed in 5-10% of cases.

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Causes of chronic cholecystitis in children

The causes of chronic cholecystitis in children are not always clear. It is assumed that the disease may be the outcome of acute cholecystitis, but the anamnesis data confirm this assumption only in some children. There are almost always indications of various infectious diseases (chronic tonsillitis, caries, appendicitis, pyelonephritis, intestinal infections, etc.). The risk of chronic cholecystitis is high in children with pancreatitis, nonspecific ulcerative colitis, Crohn's disease. Although the infection may not be diagnosed, its role in the pathogenesis of chronic cholecystitis cannot be ruled out. The significance of infection increases in the case of a decrease in the bactericidal activity of bile and a violation of the mechanisms of local nonspecific protection.

What causes chronic cholecystitis?

Symptoms of chronic cholecystitis in children

Chronic cholecystitis in children begins gradually, lasts a long time with periods of worsening (exacerbations) and improvement (remissions). Headaches, fatigue, lethargy, sleep and appetite disturbances occur. Subfebrile temperature, pale skin, dark circles under the eyes, functional changes in the cardiovascular system (tachycardia, bradycardia, arrhythmia, blood pressure surges) are possible.

The cardinal symptom of chronic cholecystitis is abdominal pain. The pain is usually dull, vague, and occurs 30-60 minutes after eating, especially fatty, fried, high-protein foods.

Symptoms of chronic cholecystitis

Classification of chronic cholecystitis

There is no generally accepted classification of chronic cholecystitis in pediatrics. The following scheme can be presented as a working classification of chronic cholecystitis in childhood.

Clinical features:

• with a predominance of the inflammatory process;
• predominance of biliary tract dyskinesia;
• the presence of stones (calculous);
• in combination with parasitic invasion (opisthorchiasis, fascioliasis, clonorchiasis, giardiasis).

Stages of the disease:

• exacerbation;
• remission.

Types of dyskinesia:

• yellow bladder (hyperkinesia, hypokinesia);
• sphincter of Oddi (hypertonicity, hypotonia).

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Diagnosis of chronic cholecystitis

X-ray examination of the gallbladder (oral, intravenous cholecystography), performed according to strict indications, allows us to judge the shape, position and motor-evacuation function of the organ. After taking a food irritant, the rate of emptying of the bladder is assessed. In the case of prolonged evacuation of the radiopaque substance, it is possible to assume a decrease in motility or difficulty in the passage of bile through the cystic duct. Cervical cholecystitis is not excluded.

Diagnosis of chronic cholecystitis

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Treatment of chronic cholecystitis in children

Creating a daily routine that is rational for the child’s age, prescribing adequate nutrition, medications and non-medicinal remedies.

During an exacerbation of chronic cholecystitis, especially with severe pain syndrome, children are hospitalized. Bed rest is prescribed, the duration of which depends on the general condition of the patient. When the exacerbation subsides, taking into account the chronic course of the disease, treatment is carried out on an outpatient basis, for example, in a one-day hospital.

How is chronic cholecystitis treated?

Forecast

The prognosis for the disease in childhood is favorable, but in the future, the formation of stones in the gallbladder and bile ducts is possible.

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