P22 – Acute Cholecystitis in the Pediatric Population

Author(s):
Katherine Davenport, Timothy Fairbanks, Nicholas Saenz, Mary Hilfiker, Stephen Bickler, Karen Kling, Julia Grabowski, Rady Children’s Hospital

Background: Gallbladder disease in children is increasing in prevalence, but little has been written specifically about acute cholecystitis (AC) in the pediatric population. The presentation, imaging findings, surgical management, and pathologic findings of AC in children are not well described.

Hypothesis: The presentation and course of AC in children differ from that in adults. Children with AC may be treated with laparoscopic cholecystectomy even when there is delayed presentation and prolonged symptoms.

Methods: We performed a retrospective review of all cholecystectomies performed at our institution between 10/2009 and 10/2013. We identified those with the pathologic diagnosis of AC and reviewed their preoperative data (demographics, diagnostic tests and preoperative length of symptoms), procedural data and outcomes.

Results: 277 patients underwent cholecystectomy during this 4 year period, with 25 patients having pathologic evidence of AC. Of these 25, 72% were female, the average age was 14 years old (2-19 y) and average BMI was 28.3 kg/m2 (range, 15.0-43.2). All patients presented with abdominal pain. The duration of symptoms ranged from 1-90 days (avg 16 d). Only 40% of patients had leukocytosis at time of admission. All 25 patients had imaging (US, MRI, CT or HIDA) reviewed by a radiologist. A radiographic diagnosis of AC was made in only 39% of those who had US (n=22), and 71% of those who had MRI (n=7); however 100% of those who had CT (n=5) or HIDA (n=2). Sixteen patients (64%) had a preoperative diagnosis of AC, and these patients underwent cholecystectomy during the initial hospitalization. The remaining 9 underwent elective cholecystectomy for cholelithiasis and were found to have AC on pathology. Twenty-four patients underwent laparoscopic cholecystectomy, 2/24 patients required conversion to open operation and one patient had an initial open cholecystectomy. Upon review of pathology, 16/25 had evidence of chronic as well as AC, 4/25 had necrosis, and 2/25 were gangrenous. 22/25 had cholelithiasis, while 3 were acalculous.

Conclusions: AC in the pediatric population is a clinical entity with a different spectrum of findings than those reported in adults. US underestimates AC, and pathology often shows concomitant acute and chronic inflammation, a combination less frequently seen in adults. Cholecystectomy should be considered in pediatric patients with acute cholecystitis even in patients with prolonged symptoms and advanced pathology.