Hopkins, James W.

Several generalizations emerge from these studies and are illustrated by our three-year-old patient. Cholecystitis in childhood is “very uncommon, probably rare,” and, “Certainly choledocholithiasis is rare” (Ulin14). An acute systemic disease is often a forerunner of acute cholecystitis in children and may be causally related in some cases; it may obscure the diagnosis. Systemic symptoms accompanying localized abdominal findings should strengthen the suspicion of acute cholecystitis. Abdominal pain and guarding and evidence of a mass are the keys to the diagnosis. The pain patterns of radiating colic and gastro-intestinal upset of the adult are not often seen in childhood. The etiology of acute noncalculous type of cholecystitis is not known. Acute symptoms of short duration and bacterial and polymorphonuclear infiltration of the wall of the gallbladder tend to distinguish childhood cholecystitis from its adult counterpart clinically and pathologically. Stones, when present, are often of hemolytic origin and occur more frequently in older children. An important difference in the surgical management of affected children as compared with adults is that jaundice alone, or stones in the gallbladder, usually do not demand exploration of the common duct. Cholecystectomy, when not contraindicated by severe associated illness, appears to be the treatment of choice.