Not Just Little Stones in Little Adults: Biliary Microlithiasis in Children Is Successfully Managed with Endoscopic Ultrasound and Laparoscopic Cholecystectomy

Objective: The objective of this study is to review the results of laparoscopic cholecystectomy to treat endoscopic ultrasound (EUS) diagnosed biliary microlithiasis in a pediatric case series. Biliary microlithiasis is an uncommon but recognized cause of upper abdominal pain, cholecystitis, cholangitis, and pancreatitis in adults. Gallstones smaller than 3 mm may not be seen on transabdominal ultrasound and may only be seen on EUS. This condition is poorly described in children.

Methods: We performed a retrospective case review of children with biliary microlithiasis who were treated with laparoscopic cholecystectomy.

Results: Three children were diagnosed with biliary microlithiasis. Two patients had recurrent right upper quadrant pain and nausea. A third patient had midepigastric pain and a diagnosis of idiopathic pancreatitis. All three had a normal gallbladder on transabdominal ultrasound. Additional imaging with hepatobiliary scan, computed tomography (CT), and magnetic resonance cholangiopancreatography (MRCP) revealed no biliary source for symptoms. EUS was performed on all three children, demonstrating microlithiasis of the gallbladder. Each child had a laparoscopic cholecystectomy with intraoperative cholangiogram (IOC). No abnormalities were seen on IOC. All three children had resolution of pain and improvement of symptoms in postoperative follow-up.

Conclusion: Children with biliary microlithiasis and associated clinical symptoms can be successfully treated with laparoscopic cholecystectomy. EUS should be considered in the evaluation of the child with clinical biliary symptoms and a negative transabdominal ultrasound.

Session: Poster

Program Number: P411

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