J Ayub Med Coll Abbottabad 2008;20(4) http://www.ayubmed.edu.pk/JAMC/PAST/20-4/Arshad.pdf 34 CHANGING SPECTRUM OF GALLSTONE DISEASE: AN EXPERIENCE OF 23 CASES LESS THAN 10 YEARS OF AGE Malik AM, Khan A, Sheikh U, Sheikh S, Laghari AA, Talpur KA Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, Sindh, Pakistan Background: An overall increase in the incidence of paediatric cholelithiasis forms the basis of this study, which aims to investigate the overall changing clinical pattern of cholelithiasis. Methods: This is a retrospective observational descriptive study including twenty three (23) patients with gallstones admitted and operated during June 2006–June 2008 in surgical department of a teaching hospital. All the patients with sonological evidence of gallstones, less than 10 years of age with history of acute or chronic abdominal symptoms are included in the study population. After admission all the subjects were investigated and finally operated by open approach (21 patients) during the same admission. The details of all the patients were recorded on a proforma and statistical analysis done on SPSS version 12. Results: Of the total study population, there were 19 (82.6 %) males and 4 (17.39%) females with a mean age of 7 years and a range of 4–10 years. Ultrasound revealed gallstones in all the patients with a varying proportion of the walls of gallbladder. The commonest presentation was abdominal pain in the right upper quadrant, which was vague, and of mild to moderate intensity. In 21 (91.30%) patients, no specific underlying cause was found while two patients (8.6%) had haematological disorder as underlying cause for the gallstones. Conclusion: This study indicates an alarming increase in the incidence of idiopathic gallstones in children less than 10 years of age with a distinct male predominance. Keywords: Cholelithiasis, children, idiopathic gallstones, Haematological disorders. INTRODUCTION Gallstone disease is a common problem in elderly women and there has been a very well known association of this disease with obesity and mulltiparity. The disease has been found very infrequently in children. 1–4 There is a dramatic change in the overall spectrum of this disease and a global increase in the incidence in young children. 5–8 This has been attributed to a better understanding of acute paediatric problems coupled with efficient use of Ultrasonography. 9 In addition, a number of conditions have a proven association with the formation of gallstones in children including TPN, Haematological disorders, Sepsis, and hepato biliary disease. 10–12 Furthermore, an association with use of ceftriaxones is also claimed to act as a strong factor causing cholelithiasis in children. 3,13 This study documents an alarming increase in the incidence of cholelithiasis in children. SUBJECTS AND METHODS It’s a retrospective descriptive study conducted in a teaching hospital from June 2006 through June 2008, including 23 patients of ultrasonologically confirmed cholelithiasis, less than 10 years of age. The study population includes both males and females. All patients with ultrasonologic evidence of calculi were included and those with sludge and gravel as well as patients over ten years of age were excluded from the study. In addition to ultrasound, LFT’s, complete blood picture, a peripheral smear, and plain x-ray abdomen were performed in all patients. The details of all these patients including presentation, laboratory work up, treatment offered and outcome are recorded on a proforma and statistically analysed on SPSS-12. RESULTS Twenty-three patients of symptomatic cholelithiasis under 10 years of age are evaluated in this study. The sex distribution in the study population is shown in Figure-1 with an obvious male dominance. The mean age of study population is 7 years with a range of 4–10 years. The commonest presenting feature was vague upper quadrant abdominal pain with or without associated nausea and vomiting as shown in Figure-2. Fourteen (61%) patients had simple gallstone disease without any complication while acute and chronic cholecystitis was found in 3 (13%) and 4 (17%) cases respectively as shown in Table- 1. All the complications were more common among the male patients compared to the female counterparts. In 21 (91%) patients no specific underlying cause or pre- disposing factor was found on laboratory and clinical work-up while only 2 (9%) patients were found to have sickle cell disease as the underlying cause of the gallstones. Three of the patients had a positive family history of gall stones while one patient had diabetes mellitus diagnosed at the age of 4 years. Remaining patients had insignificant history with regards to the present illness. Twenty-one (91.30%) patients were operated by open cholecystectomy while 2 (9%) patients were treated conservatively. Maximum number of patients (75%) was discharged in 3–6 days as shown in Figure-3. There were no complications due to surgery other than one case of wound infection that led to partial wound dehiscence and prolonged the hospital stay for about two weeks.