Cholelithiasis Diagnosis and Management in Thalassemia

Authors

  • Ervina Luki Damayanti Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Pramita Gayatri Gastroenterology Division, Department of Child Health, Universitas Indonesia, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia

DOI:

https://doi.org/10.58427/apghn.3.2.2024.15-25

Keywords:

beta-thalassemia major, cholecystectomy, cholelithiasis, endoscopic retrograde cholangiopancreatography

Abstract

Background: Cholelithiasis, while infrequently found in children, carries a significant risk for those with underlying conditions like thalassemia compared to the general population. This study aimed to described the manifestations of cholelithiasis in thalassemic children.

Case: A 12-year-old girl with beta-thalassemia major presented with recurrent right upper quadrant abdominal pain and vomiting. Imaging revealed cholelithiasis and choledocholithiasis. Due to complications related to her thalassemia, she underwent endoscopic retrograde cholangiopancreatography (ERCP) for gallstone removal followed by laparoscopic cholecystectomy. Post-operative management addressed post-ERCP pancreatitis and bleeding concerns. The patient recovered well and is scheduled for follow-up.

Discussion: Increased bilirubin production, iron overload, and altered bile properties in beta-thalassemia contribute to cholelithiasis risk. The patient presented with typical symptoms and underwent successful laparoscopic cholecystectomy after initial management with ERCP, which led to post-ERCP pancreatitis.

Conclusion: This case underscores the elevated risk of cholelithiasis in thalassemic children and the importance of early diagnosis and intervention for optimal outcomes.

References

Shaikh NM. Gall Stones in Pediatric Population [Internet]. In: Qiang Y, Huaping S, editors. Gallstones. 1st ed. Rijeka: IntechOpen; 2021 [cited 2024 May 15]. Available from: https://www .intechopen.com/chapters/77803

Premawardhena A, Fernando R, Kumarage S, Nishad N, Goonatilleke D, Silva I, Mettananda S. Place for elective cholecystectomy for patients with severe thalassaemia: a retrospective case control study. BMC Res Notes. 2019;12(1):245. https://doi.org/10.1186/s13104-019-4285- 1 DOI: https://doi.org/10.1186/s13104-019-4285-1

Zdanowicz K, Daniluk J, Lebensztejn DM, Daniluk U. The Etiology of Cholelithiasis in Children and Adolescents—A Literature Review. International Journal of Molecular Sciences. 2022;23(21):13376. https://doi.org/10.3390/ijms232113376 DOI: https://doi.org/10.3390/ijms232113376

Sun H, Warren J, Yip J, Ji Y, Hao S, Han W, Ding Y. Factors Influencing Gallstone Formation: A Review of the Literature. Biomolecules. 2022;12(4). https://doi.org/10.3390/biom12040550 DOI: https://doi.org/10.3390/biom12040550

Kementerian Kesehatan. Keputusan Menteri Kesehatan Republik Indonesia Nomor HK.01.07/Menkes/1/2018 Tentang Pedoman Nasional Pelayanan Kedokteran Tata Laksana Thalasemia. Jakarta: Kementerian Kesehatan; 2018.

Shahramian I, Behzadmehr R, Afshari M, Allahdadi A, Delaramnasab M, Bazi A. Cholelithiasis in Thalassemia Major Patients: A Report from the South-East of Iran. Int J Hematol Oncol Stem Cell Res. 2018;12(2):117-22

Tanaja J LR, Meer JM. Cholelithiasis [Internet]. Treasure Island, FL: StatPearls Publishing; 2023 [cited 2024 May 15]. Available from: https://www .ncbi.nlm.nih.gov/books/NBK470440/.

Lotfi M, Keramati P, Assdsangabi R, Nabavizadeh SA, Karimi M. Ultrasonographic assessment of the prevalence of cholelithiasis and biliary sludge in beta-thalassemia patients in Iran. Med Sci Monit. 2009;15(8):Cr398-402

Nasr MR, Shaker M, Mahdy H, Hafez A. Gall bladder contractility in children with beta-thalassaemia. East Mediterr Health J. 2009;15(2):315-21 DOI: https://doi.org/10.26719/2009.15.2.315

Tuna Kirsaclioglu C, Çuhacı Çakır B, Bayram G, Akbıyık F, Işık P, Tunç B. Risk factors, complications and outcome of cholelithiasis in children: A retrospective, single-centre review . J Paediatr Child Health. 2016;52(10):944-9. https://doi.org/10.1111/jpc.13235 DOI: https://doi.org/10.1111/jpc.13235

Serdaroglu F, Koca YS, Saltik F, Koca T, Dereci S, Akcam M, Akcam FZ. Gallstones in childhood: etiology, clinical features, and prognosis. Eur J Gastroenterol Hepatol. 2016;28(12):1468-72. https://doi.org/10.1097/meg.0000000000000726 DOI: https://doi.org/10.1097/MEG.0000000000000726

Pandian TK, Ubl DS, Habermann EB, Moir CR, Ishitani MB. Obesity Increases Operative Time in Children Undergoing Laparoscopic Cholecystectomy. J Laparoendosc Adv Surg Tech A. 2017;27(3):322-7. https://doi.org/10.1089/lap.2016.0167 DOI: https://doi.org/10.1089/lap.2016.0167

Goldman DA. Gallbladder, Gallstones, and Diseases of the Gallbladder in Children. Pediatr Rev. 2020;41(12):623-9. https://doi.org/10.1542/pir.2019-0077 DOI: https://doi.org/10.1542/pir.2019-0077

Xu Z-R, Dan H-L, Yu F. Risk factors, manifestations, diagnosis and treatment of cholelithiasis in children. World Journal of Meta-Analysis. 2021;9:54-63. https://doi.org/10.13105/wjma.v9.i1.54 DOI: https://doi.org/10.13105/wjma.v9.i1.54

Lee YJ, Park YS, Park JH. Cholecystectomy is Feasible in Children with Small-Sized or Large Numbers of Gallstones and in Those with Persistent Symptoms Despite Medical Treatment. Pediatr Gastroenterol Hepatol Nutr. 2020;23(5):430-8. https://doi.org/10.5223/pghn.2020.23.5.430 DOI: https://doi.org/10.5223/pghn.2020.23.5.430

Cahyadi O, Tehami N, de-Madaria E, Siau K. Post-ERCP Pancreatitis: Prevention, Diagnosis and Management. Medicina (Kaunas). 2022;58(9). https://doi.org/10.3390/medicina58091261 DOI: https://doi.org/10.3390/medicina58091261

Zackria R LR. Postcholecystectomy Syndrome [Internet]. Treasure Island, FL: StatPearls Publishing; 2023 [cited 2024 May 14]. Available from: https://www .ncbi.nlm.nih.gov/books/NBK539902/.

Published

2024-05-31

How to Cite

1.
Cholelithiasis Diagnosis and Management in Thalassemia. Arch Pediatr Gastr Hepatol Nutr [Internet]. 2024 May 31 [cited 2024 Jun. 23];3(2):15-2. Available from: https://apghn.com/index.php/journal/article/view/65