Cholelithiasis and cholecystitis in children after repair of congenital duodenal anomalies

Abstract

Duodenal surgery, particularly the correction of duodenal anomalies, may be associated with an increased incidence of subsequent cholelithiasis and cholecystitis in children. We review the case histories of two children. Each child experienced acute cholecystitis with gallstones nine years after the correction of duodenal anomalies (annular pancreas, duodenal stenosis) in the neonatal period. At reoperation, intense fibrosis was noted in the hepatoduodenal area, while cholangiography demonstrated abnormalities of the common hepatic and common bile ducts. These cases suggest that the correction of duodenal anomalies may favor the subsequent development of gallstones in children. Fibrosis may have compressed the common bile duct, with stasis permitting gallstone formation. Intrinsic bile duct abnormalities, which may accompany duodenal anomalies, could also play a role. Thus, a history of previous duodenal surgery in a child with abdominal pain may strengthen a tentative diagnosis of cholecystitis. Also, at the time of exploration, the surgeon should be alert to the possibility of biliary tract abnormalities.