Peculiarities of clinical course and diagnostics of calculous cholecystitis in children
DOI:
https://doi.org/10.14739/2310-1237.2013.3.22730Keywords:
калькульозний холецистит, клінічний перебіг, діагностика, дітиAbstract
Introduction. At present, the problem of bile stone disease in children is subject of the close scrutiny of not only pediatricians and pediatric surgeons. However, until now the question of tactics of their management remains debated. This is due to the insufficient number of works devoted to the dynamics of observation of the children with calculous cholecystitis and outcomes of this disease in childhood. The questions of clinical course of the disease in children depending on the stage of the disease are not clarified. The possible reasons for course and outcome of the disease are not reflected. In this regard, the nature and volume of treatment and prevention in children with cholelithiasis are not defined. All mentioned above causes the necessity of studying the peculiarities of clinical course and diagnostics of bile stone disease in children and determines the urgency of the problem.
Research objective. Analysis of the peculiarities of clinical course and diagnostics of calculous cholecystitis in children.
Materials and methods The analysis of 58 patients with calculous cholecystitis in age from 2 to 17 years was carried out. There were 39 girls (71%) and 17 boys (17%). In 35 (60%) children the conservative treatment was effective, in 23 (40%) children conservative treatment was unsuccessful and they needed surgical treatment, which consisted of cholecystectomy, made with application of laparoscopic technology. In all the children anamnesis was studied, evaluation of objective data and complex clinical, laboratory, ultrasound and x-ray examination were carried out.
Results and discussion. 3 variants of the clinical course of calculous cholecystitis were revealed: acute, chronic and asymptomatic. Acute variant of the clinical course was characterized by the sudden onset of biliary colic, which manifested in strong pain in epigastric area and in the right hypochondrium, nausea, vomiting at the height of attack. Chronic disease was characterized by dyspeptic disorders in 34.5% of cases, nagging pain in the right hypochondrium and epigastric area in 25.5% of the children, or their combination. According to ultrasound examination two variants of ultrasound picture of the stones are revealed. The first type of calculi, among which in 87% of the children cholesterol stones prevailed, was characterized by echo weakening on the surface of the stone and its transition into a weak acoustic shadow. The second type of ultrasound pictures is characterized by more expressed shadow.
Conclusions.
1. Clinical manifestations of calculous cholecystitis in children are characterized predominantly by chronic course identified in 51% of patients. In 47% of cases the course of the disease is not clinically manifested and is asymptomatic.
2. A decisive role in the diagnosis of disease is played by ultrasound examination of the gallbladder and bile ducts, which allows not only to verify the presence of concrements, but also to ascertain their nature and density.
3. Indications for laparoscopic cholecystectomy along with failure of conservative therapy are: continuing of chronic inflammation of the gall bladder with symptoms of sclerotic changes of its walls and the reduction of its contractile ability.
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