Cholecystitis, cholelithiasis and common duct stenosis in children and adolescents.

A study of 100 patients from 14 months through 18 years of age with extrahepatic biliary tract conditions who have been treated from 1950 through 1979 is reported. For discussion, these have been classified into four groups including acalculous cholecystitis, nonhemolytic cholelithiasis, hemolytic cholelithiasis and stenosis of the common duct. Ninety-nine patients were operated on and there were no deaths. Except for unusual contraindications, cholecystectomy is preferred for acute noncalculous cholecystitis. The largest number having gallstones were those patients (87%) without hemolytic disease. Only 13% had an associated hemolytic disorder. Cholecystectomy is the preferred treatment and common duct exploration is utilized when indicated. Six children with chronic relapsing pancreatitis secondary to stenosis of the ampulla of Vater and two with common duct stenosis are analyzed. Although extrahepatic biliary disorders are usually not considered in the differential diagnosis of children and adolescents with vague abdominal pain, it is evident by this large number of patients that there should be greater emphasis placed on earlier diagnosis in the future.