Gallstones

Abstract Gallstones may develop at any age. Three main factors are responsible for their formation: biliary stasis; excess bilirubin load; and lithogenic bile. Five types of gallstones are seen in children: pure cholesterol; mixed cholesterol; black pigment; brown pigment; and calcium carbonate stones. Black pigment stones are the most common and associated with haemolytic disorders, previous ileal resection, total parenteral nutrition, and neonatal abdominal surgery. Cholesterol gallstones are characteristically seen in overweight adolescent girls, often with a family history. Gallstones may be asymptomatic or present with biliary colic or acute cholecystitis; occasionally, they cause acute pancreatitis, obstructive jaundice, and/or cholangitis. Gallbladder stones are readily confirmed by a fasting abdominal ultrasound scan, whereas common bile duct stones are best diagnosed by magnetic resonance cholangiography. Clinical management depends on whether the gallstones are symptomatic and whether they are confined to the gallbladder. Asymptomatic gallbladder stones are often observed initially, with cholecystectomy being performed for persistent stones. Symptomatic gallbladder stones are treated by laparoscopic cholecystectomy. Common bile duct stones are best treated by endoscopic retrograde cholangiography and sphincterotomy, either before (the preferred option) or after cholecystectomy.