Gallstones (Cholelithiasis) | Overview
What are gallstones?
Gallstones are solid deposits of digestive fluid in the gallbladder, a small organ that sits just below the liver. Although the condition is more common in adults, about 2 percent of children of children are diagnosed with gallstones. Another word for gallstones is cholelithiasis.
Many people have gallstones without realizing it. Sometimes, however, the gallbladder becomes inflamed or a gallstone moves into a duct or passageway, creating a blockage. When this happens, a child may have abdominal pain and nausea, vomiting and/or fever.
How do gallstones form?
Normally, bile drains from the liver into the small intestine where it helps digest food. Between meals, bile is stored in the gallbladder. Sometimes bile hardens and forms gallstones. Gallstones range in size from small like a grain of sand to the size of a golf ball.
There are different types of gallstones:
- Pigment gallstones are the most common type of gallstone in children. They form when bile contains too much bilirubin, a byproduct of the body’s natural breakdown of red blood cells.
- Cholesterol gallstones are the most common form of gallstone in adults. They form when bile mixes with cholesterol and hardens.
What causes gallstones?
Girls are at higher risk than boys of developing gallstones. Other than gender, a number of factors can cause gallstones to form. The most common causes in children include:
- abnormalities in the production of red blood cells
- prolonged fasting due to illness
- use of contraceptives
- long-term parenteral nutrition
What are the symptoms of gallstones
Often, people have gallstones but no symptoms. If gallstones become symptomatic, the gallbladder typically needs to be removed. Symptoms often flare up after meals, especially meals high in fat or grease.
- pain in the upper right abdomen
When to seek emergency medical care
If a child with gallstones experiences any of the following symptoms, they need immediate medical care:
- abdominal pain that is so intense, the child can not get comfortable
- jaundice (a yellowish tint in the eyes and skin)
- fever with chills
How we care for gallstones
The Division of Gastroenterology, Hepatology and Nutrition at Boston Children’s Hospital will assess your child’s symptoms and order appropriate tests to determine the severity of the gallstones. Depending on the test results, we will determine the best course of treatment for your child with a team of physicians.
If your child has symptomatic gallstones that require surgery, surgeons in our will use a minimally invasive procedure called a laparoscopic cholecystectomy to remove the blocked gallbladder.
Gallstones (Cholelithiasis) | Diagnosis & Treatment
How are gallstones diagnosed?
If your child’s doctor suspects gallstones, they will typically order an ultrasound test. Ultrasounds use high-frequency sound waves to produce images of the internal organs. They are painless and do not expose your child to radiation.
How are gallstones treated?
If your child has gallstones but no symptoms such as pain or vomiting, they may not need treatment. Pay attention and be ready to bring your child to the doctor if they develop symptoms later.
If your child has symptomatic gallstones, the only effective treatment is surgery to remove the gallbladder. Your child’s doctor may recommend laparoscopic surgery or a procedure called ERCP. These are both minimally invasive procedures.
For a laparoscopy, small incisions are made on the child's abdomen. A telescope is passed through one of these openings to observe the operation as it is performed with instruments placed through the other openings.
For an ERCP, the doctor guides a long, thin, flexible tube equipped with LED lights and a tiny video camera into the child’s mouth, down to the upper digestive system. The doctor then slides a tool down the tube and uses it to remove the gallbladder.
Both of these procedures require general anesthesia and, typically, an overnight stay at the hospital to be monitored. Both procedures cause considerably less pain and scarring than traditional open surgery.
In rare cases, an "open" procedure through an incision below the ribs may be necessary. This may be required if there is scarring, inflammation, bleeding or unusual anatomy of the common bile duct which prevents safe performance of the laparoscopy.