Pediatric Gallbladder Diseases
What is gallbladder disease?
Gallbladder diseases in a child are inflammation, infection, gallstones or obstruction of the biliary tract. The gallbladder is a sac-like organ located under the liver. It provides storage and condensation of bile produced in the liver, helps bile digestion and ensures the absorption of fats from the intestinal tract. Bile stored in the gallbladder is secreted from the gallbladder to the first part of the intestine after eating. Among the gallbladder diseases, there are cholecystitis (inflammation or infection), gallstones, biliary dyskinesia (lack of necessary movements in the gallbladder to provide bile excretion), tissues growing into the gallbladder (gallbladder polyps).
What are the causes of gallbladder diseases?
Although gallstones are not as common as in adults, they are also seen in children. Usually, gallstones in children do not have a very obvious cause. It can be seen in some inherited blood diseases (such as spherocytosis and sickle cell disease). Other risk factors include obesity, family history, and certain medications.
What type of complaint does it make?
Gallstones are not always symptomatic. When they give symptoms, the symptoms start suddenly. Abdominal pain begins, and over time, abdominal pain is localized to the upper right part of the abdomen. It hits the back and pain may be felt in the right shoulder blade. Young children cannot describe the point of pain very well. Older children show the upper right or middle part of the blood. They describe pain in the back or at the level of the scapula. The pain may be sharp, cramping, or more vague. It disappears from time to time and starts again. It may be more severe after fatty meals.
If a gallstone blocks a duct, some symptoms may occur together or alone: nausea, vomiting, fever, and jaundice (yellow glowing appearance of the eyes and skin).
How is the diagnosis of gallbladder disease made?
Ultrasonography is the most commonly used imaging method in gallbladder disease or stones. Other tests that show gallstones and obstruction caused by stones in the biliary tract may also be performed.
Different examinations such as abdominal x-ray, magnetic resonance cholangiopancreatography or endoscopic retrograde pancreatography are valuable in diagnosis and treatment. Blood tests will show whether your child has an infection or develops jaundice due to congestion.
Treatment of gallbladder diseases in children
If the stone in the gallbladder is asymptomatic, it can be followed. It is the surgical removal of the gallbladder in symptomatic stones, this operation is called cholecystectomy. Cholecystectomy is a very common surgical procedure and patients who have undergone cholecystectomy do not have any problems with food. The child can eat normally. Bile produced in the liver passes directly to the intestines without being stored. Soft stools can be seen for a while, especially after fatty foods.
Mostly, closed (laparoscopic) surgery is performed. The surgery is completed with cameras and instruments placed in the abdomen through small incisions instead of a large surgical incision. In some cases, it is necessary to perform open surgery or switch from closed surgery to open surgery. Surgery can be performed openly, especially if he has had previous intra-abdominal surgery.
If there is a suspicion of stones falling from the gallbladder to the biliary tract, X-rays of the biliary tract may be required during the surgery. If there are stones in the biliary tract, this stone should be removed by various procedures. If the child is not young, the stone can be removed or dropped by endoscopic retrograde cholangiopancretography.
What will happen after the surgery?
After laparoscopic surgery, your child may be discharged the next day in 2 to 5 days after open surgery. Pain medications and activity restriction are required. The surgical wound should be kept clean and dry. Your child can take a bath and start school after 1 week.
In case of fever above 38 0 C, redness, tenderness, discharge at the wound site, vomiting, loss of appetite, and jaundice, you should consult a doctor.
