REGULAR ARTICLE Clinico-pathological spectrum of gallbladder disease in children RPS Punia (drpunia@gmail.com), Shailja Garg, Bhumika Bisht, Usha Dalal, Harsh Mohan Department of Pathology and General Surgery, Government Medical College & Hospital, Chandigarh, India Keywords Cholecystitis, Choledochal cyst, Cholelithiais, Gallbladder Corrospondence Dr RPS Punia, M.D., Professor, Department of Pathology, Govt. Medical College & Hospital, Chandigarh, India. Tel: +91-172-2665253 | Fax: +91-172-2665375 | Email: drpunia@gmail.com Received 31 January 2010; revised 14 March 2010; accepted 6 May 2010. DOI:10.1111/j.1651-2227.2010.01876.x ABSTRACT Aim: Because of wide variation in clinico-pathological spectrum of gallbladder disease in children the world over, the data of gallbladder disease from this stone belt of India were analysed. Methods: Children who underwent cholecystectomy over a period of 8 years January 2002–December 2009 were reviewed. Results: Out of 7076 cholecystectomies, 56 (0.79%) were in children. Thirty-nine (69.6%) children were 11–16 years of age. Thirty-seven (66.07%) children were girls and nineteen (33.9%) were boys. In 12 (21.4%) children, cholecystitis was acalculus. Five (8.9%) children had associated haemolytic disease and 4 (7.1%) children had congenital anomaly in the form of choledochal cyst. Ultrasound findings were available in 44 cases and showed cholelithiasis in 36 cases. Twenty-two (39.3%) children had mixed cholelithia- sis, 8 (14.2%) pigment cholelithiasis, 10 (17.8%) combined cholelithiasis and 4 (7.1%) patients had small concretions. Microscopically, changes of chronic cholecystitis were seen in 98.2% while 1.7% showed acute on chronic cholecystitis. There was single unusual case of cysticercus in the wall of the gallbladder. Conclusions: The frequency of gallstone disease is 0.79%. Nonhaemolytic type of cholelithiasis is more common than haemolytic type in this region. Presence of cysticercus in the gallbladder wall in one case was an unexpected finding. INTRODUCTION Gallbladder disease in children is uncommon and presents a unique pathological spectrum (1,2). Cholelithiasis with or without cholecystitis which is seen in childhood may be associated with haemolytic disease, congenital anoma- lies, infection and bile stasis (3–6). There are few reports in literature studying the pathological spectrum of gall- bladder disease in children. Most of them focus on the class associated with haemolytic diseases, whereas, chole- lithiasis without haemolysis also contributes to the signifi- cant proportion of cases. The current study was undertaken to know the clinico-pathological spectrum of gallbladder disease in children in this gallstone belt of India as there are occasional case reports in this age group in the literature. MATERIALS AND METHODS The clinical and histo-pathological records of all children (<16 years) who underwent cholecystectomy over a period of 8 years (January 2002–December 2009) at Government Medical College and Hospital, Chandigarh and General Hospital, Chandigarh, were reviewed. Medical records of all these children were analysed. Data pertaining to patient age, sex, clinical history, ultrasonic findings and the findings on pathological examination were noted. RESULTS A total of 7076 cholecystectomies were performed for cho- lecystitis or cholelithiasis at Government Medical College and Hospital, Chandigarh and General Hospital, Chandi- garh over a period of 8 years. Out of these, 56 (0.79%) were children £16 years of age. Six (10.7%) children were £5 years, 11 (19.6%) children 6–10 years and 39 (69.6%) were 11–16 years of age. There were 37 (66.07%) girls and 19 (33.9%) boys with ratio of (1.95:1). Clinically, 37 (66.07%) children presented with symptomatic gallstone disease, 3 (5.3%) patients had asymptomatic gallstone dis- ease and 12 (21.42%) had acalculus cholecystitis while 4 (7.1%) had congenital anomaly in the form of choledochal cyst. Out of 56 cases, only 5 (8.9%) (four boys, one girl) had evidence of an underlying haemolytic disease. Four out of these cases were symptomatic for gallstones while one had asymptomatic cholelithiasis. The clinical findings are sum- marized in Table 1. The most common symptom was pain but nausea and dyspepsia were also observed. One of the patients with asymptomatic gallstone was a known case of haemolytic anaemia, which underwent abdominal ultra- sound (USG) for assessment of spleen size and was found to have concomitant gallstones. In the other two patients, inci- dental gallstones were found at the time of investigations for blunt trauma abdomen and epigastric hernia. USG findings were available in 44 cases and revealed cholelithiasis in 36 Acta Pædiatrica ISSN 0803–5253 ª2010 The Author(s)/Journal Compilation ª2010 Foundation Acta Pædiatrica/Acta Pædiatrica 2010 99, pp. 1561–1564 1561