Treatment of Cholelithiasis in Children with Congenital Heart Disease

Abstract

Congenital heart disease (CHD) is a risk factor for cholelithiasis, but the therapeutic guidelines for cholelithiasis in children with CHD as an underlying disease have not been established yet. A total of 15 children with CHD who were diagnosed with cholelithiasis in our hospital from January 2015 to December 2020 were enrolled in this study to clarify the therapeutic guidelines. Their CHDs included cyanotic heart disease in 13 children. Their ages when they were first diagnosed ranged from 24 days after birth to 9 years and 4 months of age. When they were first seen at our hospital, 13 children had gallbladder stones and in three of the 13, the stones had fallen into the common bile duct. Although ursodeoxycholic acid was administered to 10 children, their stones had not shrunk. Cholecystectomy was performed in six children. Four out of five children who had common bile duct stone presented with strong symptoms, but their stones were spontaneously dissolved. In the remaining one child, the stone was removed by using an endoscope. Gallbladder stone in children with CHD is associated with complication in a high frequency and the prognosis of children who develop complications is poor. Bile acid litholysis is also ineffective. Accordingly, we should consider cholecystectomy even if the child patient is asymptomatic. We can expect spontaneous dissolution of common bile duct stone, but endoscopic or surgical choledocolithotomy is useful, if the stone is not dissolved.