Non-hemolitic cholelithiasis in infancy and adolescence : etary distribution, clinical manifestations, fiagnosis, predisposal factors, treatment and complications in 65 patients / Colelitiase não-hemolitica na infancia e na adolescencia : distribuição etaria, manifestações clinicas, diagnostico, fatores predisponentes, tratamento e complicações em 65 pacientes

AUTOR(ES)
DATA DE PUBLICAÇÃO

2006

RESUMO

There is a poor knowledge on the epidemiology and the best therapy of cholelithiasis in childhood. The number of cases is increasing, some requiring surgery which implies in risks and complications. The aim of this study was to evaluate the probable features involved in nonhemolitic cholelithiasis in children and adolescents, as an attempt to elucidate features related to risk factors, clinical picture, diagnosis, as well as the presence of associated diseases, complications, family history and medical treatment. Sixty-five patients from age 0 to 18 years with nonhemolitic cholelithiasis were followed from January 1993 to December 2005 at the Hospital of State University of Campinas. The study was descriptive, retrospective and prospective, and the data were collected from patients´ records and interviews. The patients? parents were investigated for cholelithiasis by ultrassonography. The laboratorial investigation of patients consisted in the lipidic profile (total cholesterol, fractions and triglyceride dosage) and hepatic profile (aminotransferases and gama-GT). A case-control study was also performed in order to investigate the influence on those children whose mothers had cholelithiasis. Forty-six of 65 patients were female (70.77%), with a predominance of females among scholars and adolescents. Caucasians corresponded to 69.23% (45/85) and the mean age at diagnosis was 9.85 years. The symptomatic patients represented 69.23% (45/65), mainly over 7 years, and the main symptoms and signs were: abdominal pain (45), vomiting (27), nauseas (22), post-prandial discomfort (16), jaundice (12) and fat food intolerance (9). The median time lapse from the beginning of clinical presentation up to diagnosis was 6 months. The associated conditions and risk factors were present in 43 patients (66.15%), mainly below 14 years (frequent prematurity below 6 years). Lipidic and hepatic abnormalities occurred, respectively, in 21/43 (48.84%) and 14/49 cases (28.57%). Complications (choledocolithiasis and pancreatitis) were rare, with predominance in adolescents. Fifty-one patients (78.46%) underwent cholecystectomy. Ten mothers were diagnosed with cholelithiasis and 36 out of 57 patients (63.16%) presented family history of cholelithiasis. Based on these results, the conclusions were: 1.The prevalence in females predominated increasingly in the second group; 2. Frequent complains were: abdominal pain, vomiting, nauseas and post-prandial discomfort; 3. The diagnoses of symptomatics were late; 4. Patients older than 7 years were the most symptomatic and those below 14 years of age had a greater tendency towards associated diseases and risk factors. 5. Relevant risk factors and associated illnesses were: parenteral antibiotics, prolonged parenteral nutrition, abdominal surgery, portal hypertension and prematurity; 6. Hepatical patology and altered hepatic perfil were frequent; 7. Obesity and severe dislipidemia were not frequent; 8.Cholelithiasis and biliary pancreatitis were rare complications, predominating in adolescents; 9. Most patients received laparoscopic cholecystectomy; 10. Most cases had suggestive medical history and(or) family antecedent of cholelithiasis; 11. Family antecedent of dislipidemia, obesity and urolithiasis occurred in half of the patients; 12. The influence of mothers presenting antecedents for cholelithiasis on children and adolescents was not confirmed

ASSUNTO(S)

cholelithiasis adolescence colelitiase adolescentes

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