The gallbladder is a small sac-like organ located under the liver. Its function is to store and concentrate bile produced in the liver and then send it onward through the bile ducts. When we eat food, especially fatty foods or meat, the gallbladder secretes bile into the first section of the small intestine, known as the duodenum. The bile then mixes with your food and helps to digest and break down the fat. In addition, bile also helps in the process of eliminating waste from the liver and the removal of cholesterol from the body. Gallstones is a disease more commonly found in adults, but it can also be found in children. However, although the incidence rate of gallstones in children (pediatric gallstones or cholelithiasis) is not high, the numbers are higher than previously and they are increasing. A population based study estimated the prevalence of gallstones and biliary sludge in children at 1.9% and 1.46% respectively. There are many factors that can cause gallstones, some of which are not completely known.
The causes of gallstones in children differ from those in adults (cholesterol gallstones are the most common type of gallstones found in adults). In children, black pigment gallstones are most common. These are caused by a breakdown of blood cells in children with blood diseases. Calcium carbonate stones and cholesterol stones are the next most common, respectively.
Most gallstones remain lying in the lower region of the gallbladder and do not cause any symptoms and thus do not require any treatment. However, when the gallbladder contracts to allow bile to flow into the small intestine, the gallstones can be driven along with the bile into the neck of the gallbladder and may cause a blockage to the cystic duct, causing sudden pain on the upper right side of the abdomen. Some people experience only a little pain, perhaps a dull ache, like they have indigestion. Others, however, experience a great deal of pain, sometimes to the point that they are hunched over. The pain can be sharp and intense, even radiating up to the shoulder blade or just below the shoulder on the right side. In some cases, the gallstone blocking the opening to the cystic duct may fall back into the gallbladder itself, causing the blockage and pain to disappear. In other cases, however, the gallstone can move further forward, worsening blockage to the cystic duct or common bile duct, causing infection and inflammation of the gallbladder and pancreatitis. This results in bile from the liver being obstructed and thus, symptoms to increase as follows:
Examination is carried out with a procedure called Endoscopic Retrograde Cholangiopancreatogram (ERCP). This involves an endoscope (a long, flexible, lighted tube) being put into the child’s mouth and then gently moved down all the way to the duodenum. Next, a tube will be passed through the scope into the common bile duct and a contrast medium is then injected into the bile duct so that an x-ray can be taken (This method is used for adults and older children). These x-ray images can show whether there are gallstones present in the bile duct or not. If stones are present, further procedures can be carried out to cut and expand the opening of the bile duct using a stent, and/or to remove stones from the common bile duct.
In addition to the endoscopic examination as outlined above, stones in the bile ducts can also be seen using a procedure known as a Magnetic Resonance Cholangio Pancreatography (MRCP). Although this does not involve the use of an x-ray and is non-invasive, and thus not painful, the disadvantage of this procedure is that it only provides images but does not allow for performing additional procedures for inserting stents or removing gallstones from ducts.
Although gallstone surgery poses greater risk than leaving the stones untouched and actively monitoring them, 70% of children who have experienced abdominal pain from gallstones will develop the symptoms again within 2 years if they do not receive surgery to remove the stones. Also, in some cases, more severe symptoms can arise as a result of complications, such as severe inflammation of the gallbladder (acute cholecystitis) or gallstones causing blockage to the bile ducts and infection in the bile ducts (cholangitis), and these can prove fatal if not treated properly and in a timely manner.
Most gallbladder surgery is not complicated and can be accomplished by 2 main methods. One of these is open surgery (Open Cholecystectomy). However, we are happy to announce that today, Samitivej Hospital provides the technology needed to perform laparoscopic surgery (Laparoscopic Cholecystectomy) for use in the treatment of up to 100% of cases of pediatric gallstones. This procedure involves making 3-4 small incisions in the abdomen. A lighted scope attached to a video camera (laparoscope) is then inserted through one of these small incisions. The laparoscope is very small, with the smallest sizes starting at 2-5 mm in diameter. From there, the surgeon inserts other tiny surgical instruments which he or she will use to perform the procedure to remove the gallbladder along with the gallstones through one of the incisions.
This type of surgery requires much smaller incisions than in traditional open surgery, which means that children will experience less pain from their surgical wounds and thus also results in far shorter recovery periods so that the children can return home or to school much more quickly after surgery. The rate of infection of surgical wounds is also hugely decreased due to the greatly reduced incision size, further benefiting pediatric patients.
Samitivej Children’s Hospital
Tel: 66 (0)2 022-2236-40
Call Center: 66 (0) 2022-2222
Faculty of Medicine, Khon Kaen University. , 2000