Acute cholecystitis in children

Acute cholecystitis in children - acute inflammation of the gallbladder.

ICD-10 code

K81.0. Acute cholecystitis.

Epidemiology of acute cholecystitis

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

[1], [2], [3], [4], [5], [6], [7], [8], [9]

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 fever). The pathogenetic role of enzymes and proenzymes of the pancreas, entering the bile ducts and the gallbladder and provoking acute fermentative cholecystitis, is investigated.

What causes acute cholecystitis?

[10], [11], [12], [13]

Pathomorphology

Catarrhal cholecystitis is an inflammation limited to the mucosa and submucosa, characterized by swelling and thickening of the gallbladder wall, an increase in its size. The mucous membrane is hyperemic, infiltrated by cellular elements, has hemorrhagic sites. As the acute inflammatory changes are eliminated, fibrosis occurs. In the case of deposition of fibrin, spikes are formed, which cause deformation of the organ. When the bladder duct is blocked (scars, stone), a drop of the gallbladder develops, often flowing secretly.

With phlegmonous cholecystitis purulent inflammation with infiltration captures all layers of the thickened wall of the gallbladder. The organ is enlarged, fibrin is covered externally, the mucous membrane is sharply hyperemic or reddish brown, covered with fibrin, sometimes necrotic with single or multiple ulcers. In the wall of the gallbladder, the formation of abscesses that break into the bladder or its bed is possible. The contents of the bladder can be bile, inflammatory exudate, pus. In the case of obliteration of the cystic duct, the empyema of the gallbladder develops.

Gangrenous cholecystitis is characterized by pronounced morphological changes of the gallbladder, resulting from significant disorders of blood supply, including thrombosis of blood vessels. Gangrene captures the mucous membrane of the organ, can be focal, in rare cases necrosis of the entire bladder; 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 the gallbladder is catarrhal cholecystitis.

Symptoms of acute cholecystitis in children

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

Pre-school children (up to 7 years) and primary school age (8-11 years old) have abdominal pains that are diffuse or indeterminate, which creates diagnostic difficulties and provokes medical errors. In patients of adolescence (12-13 years) the pain is severe, sharp, the "dagger" character begins to localize in the right hypochondrium. Note the irradiation of such pain in the right shoulder, scapula, right half of the back and iliac region.

Symptoms of acute cholecystitis

Classification of acute cholecystitis

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

[14], [15], [16], [17], [18], [19]

How to recognize acute cholecystitis in children?

The data of the anamnesis, as a rule, are not informative, the disease develops suddenly. When examining a sick child determine the forced position, icterus of the skin. Palpator is the area of maximum abdominal tenderness (right hypochondrium), the size of the liver and spleen.

Diagnosis of acute cholecystitis

Treatment of acute cholecystitis in children

Children with acute cholecystitis are urgently hospitalized. Assign a strict bed rest, supervision of a pediatrician, a pediatric surgeon and other specialists to determine the tactics of reference.

Abstinence from food intake is shown. If children of preschool age (up to 7 years) and school age with a catarrhal form of acute cholecystitis have a certain time without food, then an individual approach is necessary for patients of early age (up to 3 years). It is not excluded parenteral nutrition.

How is acute cholecystitis treated?

Forecast

With early diagnosis and targeted treatment, the prognosis of 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.

[20], [21]