Gallstone-related morbidity in Jamaican children with homozygous sickle-cell disease: a six-year review

ABSTRACT

The clinical details of 17 patients aged 18 years and under with homozygous sickle-cell disease (SS) who presented with gallstone-related symptoms to the University Hospital of the West Indies, and the Bustamante Hospital for Children are analysed. All patients had right upper quadrant signs pre-operatively and all were confirmed to have acute or chronic cholecystitis based on gallbladder (GB) histology. Other gallstone-related complications were obstructive jaundice in 2, mucocoele of the GB in 1 and GB empyema in 1. While 16 of 17 had gallstones detected preoperatively ultrasound, only 2 of 6 patients later confirmed to have common bile duct (CBD) stones, were also detected. One patient had retained CBD stones post-operatively which were successfully dislodged by saline irrigation via t-tube. There was no mortality but 3 patients developed the acute chest syndrome, 4, unexplained pyrexia and 1, wound abscess. We believe that gallstone-related morbidity in children with SS disease may so far be underestimated. Even the youngest develop life-threatening complications. The risk of associated choledocholithiasis and obstructive complications may be just as high in paediatric SS disease patients with gallstones as in adults similarly affected (AU)