Chronic cholecystitis in children

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

ICD-10 code

K81.1. Chronic cholecystitis.

Epidemiology of chronic cholecystitis in children

Data on the prevalence of chronic cholecystitis among patients of childhood are absent. In surgical practice, patients with suspicion of cholelithiasis in 5-10% of cases are established "acuminate" cholecystitis.

[1], [2], [3]

The causes of chronic cholecystitis in children

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

What causes chronic cholecystitis?

Symptoms of chronic cholecystitis in children

Chronic cholecystitis in children begins gradually, proceeds for a long time with periods of deterioration (exacerbations) and improvement (remissions). There are headaches, fatigue, lethargy, sleep and appetite disorders. Possible subfebrile condition, pale skin, dark circles under the eyes, functional changes in the cardiovascular system (tachy, bradycardia, arrhythmia, blood pressure jumps).

Cardinal symptom of chronic cholecystitis is a pain in the abdomen. The pain is usually dull, indeterminate, occurs 30-60 minutes after eating, especially greasy, fried, high protein.

Symptoms of chronic cholecystitis

Classification of chronic cholecystitis

The generally accepted classification of chronic cholecystitis in pediatrics has not been developed. As a working classification of chronic cholecystitis in childhood, the following scheme can be presented.

Clinical features:

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

Stages of the disease:

• exacerbation;
• remission.

Types of dyskinesia:

• bile ducts (hyperkinesia, hypokinesia);
• sphincter of Oddi (hypertonicity, hypotension).

[4], [5]

Diagnosis of chronic cholecystitis

X-ray examination of the gallbladder (oral, intravenous cholecystography), carried out according to strict indications, allows to judge the form, position and motor-evacuation function of the organ. After receiving the food stimulus, the rate of emptying the bladder is estimated. In the case of a prolonged evacuation of the radiopaque substance, one can assume a decrease in motility or difficulty in passing the bile through the bladder duct. Cervical cholecystitis is not excluded.

Diagnosis of chronic cholecystitis

[6], [7], [8], [9]

Treatment of chronic cholecystitis in children

Creating a rational for the child's age regime of the day, the appointment of adequate nutrition, drug and non-pharmacological agents.

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

How is chronic cholecystitis treated?

Forecast

The prognosis of the disease in childhood is favorable, but later the formation of concrements in the gallbladder and bile ducts is possible.

[10]