Pediatric Cholecystitis Differential Diagnoses

  • Author: Steven M Schwarz, MD, FAAP, FACN, AGAF; Chief Editor: Carmen Cuffari, MD   more...
 
Updated: Mar 29, 2011
 
 

Diagnostic Considerations

The differential diagnosis of cholecystitis is based on the presenting symptom of right upper quadrant abdominal pain. In the pediatric population, consider the following conditions in addition those listed in Differentials:

  • Biliary colic
  • Cholangitis
  • Rupture of the gallbladder
  • Peptic ulcer disease
  • Renal colic
  • Gastritis
  • Pleurisy
  • Fitz-Hugh and Curtis syndrome (gonococcal perihepatitis)
  • Hepatic abscess
  • Abdominal tumor
  • Pyelonephritis

Infants with cholecystitis may present with irritability, jaundice, and acholic stools. Because of young age and differing presentation, consider congenital bile duct anomalies, such as biliary atresia and paucity of intrahepatic bile ducts.

Acalculous cholecystitis usually occurs in children with preexisting systemic illness and, therefore, may be masked by other conditions and analgesics. Be sensitive to the possibility of cholecystitis if systemic infection and multiple risk factors are present.

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Steven M Schwarz, MD, FAAP, FACN, AGAF  Professor of Pediatrics, Children's Hospital at Downstate, SUNY-Downstate Medical Center

Steven M Schwarz, MD, FAAP, FACN, AGAF is a member of the following medical societies: American Academy of Pediatrics, American College of Nutrition, American College of Physician Executives, American Gastroenterological Association, American Pediatric Society, Gastroenterology Research Group, New York Academy of Medicine, North American Society for Pediatric Gastroenterology and Nutrition, and Society for Pediatric Research

Disclosure: Curemark, LLC Consulting fee Board membership; Centocor, Inc. Grant/research funds Independent contractor; Johnson & Johnson, Inc. Grant/research funds Independent contractor

Coauthor(s)

Andre Hebra, MD  Chief, Division of Pediatric Surgery, Professor of Surgery and Pediatrics, Medical University of South Carolina College of Medicine; Surgeon-in-Chief, Medical University of South Carolina Children's Hospital

Andre Hebra, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, Children's Oncology Group, Florida Medical Association, International Pediatric Endosurgery Group, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Laparoendoscopic Surgeons, South Carolina Medical Association, Southeastern Surgical Congress, and Southern Medical Association

Disclosure: Nothing to disclose.

Melissa Miller, MD  Department of Surgery, Medical University of South Carolina

Melissa Miller, MD is a member of the following medical societies: American Medical Association and American Medical Student Association/Foundation

Disclosure: Nothing to disclose.

Specialty Editor Board

Jeffrey J DuBois, MD  Chief of Children's Surgical Services, Division of Pediatric Surgery, Kaiser Permanente, Women and Children's Center, Roseville Medical Center

Jeffrey J DuBois, MD, is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, and California Medical Association

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Chief Editor

Carmen Cuffari, MD  Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine

Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

References

  1. Akiyoshi T, Nakayama F. Bile acid composition in brown pigment stones. Dig Dis Sci. Jan 1990;35(1):27-32. [Medline].

  2. Stephen AE, Berger DL. Carcinoma in the porcelain gallbladder: a relationship revisited. Surgery. Jun 2001;129(6):699-703. [Medline].

  3. Baldwin M, Eisenman RE, Prelipp AM, Breuer RI. Ascaris lumbricoides resulting in acute cholecystitis and pancreatitis in the Midwest. Am J Gastroenterol. Dec 1993;88(12):2119-21. [Medline].

  4. Kong MS, Chen CY. Risk factors leading to ceftriaxone-associated biliary pseudolithiasis in children. Chang Keng I Hsueh. Mar 1996;19(1):50-4. [Medline].

  5. Schaad UB, Wedgwood-Krucko J, Tschaeppeler H. Reversible ceftriaxone-associated biliary pseudolithiasis in children. Lancet. Dec 17 1988;2(8625):1411-3. [Medline].

  6. Weinstein S, Lipsitz EC, Addonizio L, Stolar CJ. Cholelithiasis in pediatric cardiac transplant patients on cyclosporine. J Pediatr Surg. Jan 1995;30(1):61-4. [Medline].

  7. Callahan J, Haller JO, Cacciarelli AA, et al. Cholelithiasis in infants: association with total parenteral nutrition and furosemide. Radiology. May 1982;143(2):437-9. [Medline].

  8. Heubi JE, O'Connell NC, Setchell KD. Ileal resection/dysfunction in childhood predisposes to lithogenic bile only after puberty. Gastroenterology. Aug 1992;103(2):636-40. [Medline].

  9. Tsakayannis DE, Kozakewich HP, Lillehei CW. Acalculous cholecystitis in children. J Pediatr Surg. Jan 1996;31(1):127-30; discussion 130-1. [Medline].

  10. [Guideline] Guralnick S, Serwint J. Cholelithiasis and cholecystitis. Pediatr Rev. Sep 2009;30(9):368-9; discussion 369. [Medline].

  11. Friesen CA, Roberts CC. Cholelithiasis. Clinical characteristics in children. Case analysis and literature review. Clin Pediatr (Phila). Jul 1989;28(7):294-8. [Medline].

  12. Bennion LJ, Knowler WC, Mott DM, et al. Development of lithogenic bile during puberty in Pima indians. N Engl J Med. Apr 19 1979;300(16):873-6. [Medline].

  13. Imhof M, Raunest J, Ohmann C, Roher HD. Acute acalculous cholecystitis complicating trauma: a prospective sonographic study. World J Surg. Nov-Dec 1992;16(6):1160-5; discussion 1166. [Medline].

  14. Agrawal CS, Sehgal R, Singh RK, Gupta AK. Antibiotic prophylaxis in elective cholecystectomy: a randomized, double blinded study comparing ciprofloxacin and cefuroxime. Indian J Physiol Pharmacol. Oct 1999;43(4):501-4. [Medline].

  15. Suell MN, Horton TM, Dishop MK, Mahoney DH, Olutoye OO, Mueller BU. Outcomes for children with gallbladder abnormalities and sickle cell disease. J Pediatr. Nov 2004;145(5):617-21. [Medline].

  16. Ware R, Filston HC, Schultz WH, Kinney TR. Elective cholecystectomy in children with sickle hemoglobinopathies. Successful outcome using a preoperative transfusion regimen. Ann Surg. Jul 1988;208(1):17-22. [Medline].

  17. Lugo-Vicente HL. Trends in management of gallbladder disorders in children. Pediatr Surg Int. Jul 1997;12(5-6):348-52. [Medline].

  18. Siddiqui S, Newbrough S, Alterman D, Anderson A, Kennedy A Jr. Efficacy of laparoscopic cholecystectomy in the pediatric population. J Pediatr Surg. Jan 2008;43(1):109-13; discussion 113. [Medline].

  19. Sigman HH, Laberge JM, Croitoru D, et al. Laparoscopic cholecystectomy: a treatment option for gallbladder disease in children. J Pediatr Surg. Oct 1991;26(10):1181-3. [Medline].

  20. St Peter SD, Keckler SJ, Nair A, et al. Laparoscopic cholecystectomy in the pediatric population. J Laparoendosc Adv Surg Tech A. Feb 2008;18(1):127-30. [Medline].

  21. Holcomb GW 3rd, Morgan WM 3rd, Neblett WW 3rd, et al. Laparoscopic cholecystectomy in children: lessons learned from the first 100 patients. J Pediatr Surg. Aug 1999;34(8):1236-40. [Medline].

  22. Walker TM, Hambleton IR, Serjeant GR. Gallstones in sickle cell disease: observations from The Jamaican Cohort study. J Pediatr. Jan 2000;136(1):80-5. [Medline].

  23. z. Treatment of gallstones in the 1990s. Prim Care. Sep 1996;23(3):497-513. [Medline].

 
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Diagram illustrating the technique for laparoscopic cholecystectomy. The gallbladder is retracted with grasping 5-mm laparoscopic instruments, and clips are applied over the cystic duct and artery.
Photograph of a gallbladder filled with numerous small cholesterol stones.
Operative photograph illustrating the position of small (5 mm, 10 mm) trocars in the abdomen of a 12-year-old child undergoing laparoscopic cholecystectomy. By using this technique, the surgeon can avoid large incisions and remove the gallbladder safely.
Photograph illustrating the role of endoscopic retrieval of common bile duct stones. The picture shows a balloon placed via the endoscope into the ampulla for extraction of a cholesterol stone that was occluding the common bile duct.
 
 
 
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