Objective: After noting a marked rise in cholecystectomies in the pediatric population, this study looked for trends in patient demographics, risk factors, clinical presentations, diagnostic procedures, treatment procedures, and primary diagnoses of pediatric patients undergoing cholecystectomy from 1994-2000 in the community hospital setting in Salem, Oregon.
Methods: A retrospective chart review of 116 patients ages birth to 18 years undergoing cholecystectomy at Salem Hosptial between 1994-2000.
Results: 87% (101) of the subjects were female and 13% (15) were male. 76% (88) were white, 17% (20) Hispanic, and 1% black. The average age was 15.88 years (SD=2.47) and 96% (111) were 11-18 years. 75% (87) of the females were postmenarchal and 32% (37) had a history of pregnancy. 61% of the subjects were obese (BMI>25). Only 2% or less had hemolytic disease, history of TPN, or ileal disease or resection. 53% (61) had normal liver function lab values. 82% (95) presented with right upper quadrant or epigastric pain, 53% (61) with nausea and/or vomiting, and 4% (5) with a fever. (99% (115) had an ultrasound as part of the diagnostic workup. The most common diagnosis was biliary colic/cholelithiasis/chronic cholecystitis with 91% (106). 91% (105) had a laparoscopic cholecystectomy and 83% (96) had an IOC.
Conclusion: There had been an increased incidence of pediatric cholecystectomies since the early 1990's at Salem Hospital in Salem, Oregon. According to this study the major risk factors for pediatric gallbladder disease include: female gender, post menarche, history of pregnancy, and obesity. The most common presenting symptoms for ages 11-18 include right upper quadrant or epigastric pain and nausea/vomiting. With 53% of the subjects having normal liver function lab values it is clear that they should not be relied upon for diagnosis. Ultrasound is the diagnostic procedure of choice and laparoscopic cholecystectomy is the treatment of choice.
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