Gallbladder Disease

What is gallbladder disease?

Gallbladder disease includes inflammation, infection, stones, or blockage of the gallbladder. The gallbladder is a sac-like organ located under the liver. It stores and concentrates bile produced in the liver, which aids in the digestion and absorption of fat. Bile is made in the liver and stored in the gallbladder. It is then released from the gallbladder into the upper small intestine in response to food (especially fats). 

Types of gallbladder disease include:

  • Cholecystitis (inflammation of the gallbladder) 
  • Gallstones 
  • Biliary dyskinesia (in which the natural movements needed to empty the gallbladder do not work well)
  • Growths of tissue (polyps) in the gallbladder

What causes gallbladder disease in children?

Although gallstones are not as common in children as they are in adults, some children do get gallstones. Most often, there is no specific underlying cause for gallstones in children. But some factors can put children at increased risk for gallstones are:
  • Having certain inherited blood problems, such as or spherocytosis 
  • Being obese 
  • Having a family history of gallstones 
  • Taking certain medicines

Symptoms

Sometimes gallstones form, but cause no symptoms. When gallstones do cause symptoms, the symptoms tend to come on suddenly.

The most common symptom is pain in the upper belly (abdomen). This pain gets worse and lasts for at least 30 minutes. It may last for as long as a few hours. Your child may feel that the pain is centered on the upper right side of the belly and it sometimes radiates to the back.

It is difficult for most younger children to pinpoint the exact location of their pain. They may seem vague about where they hurt. Those that are able to describe their pain would likely state the following about the pain:
  • Centering in the right upper or middle upper belly 
  • Spreading to the back or between the shoulder blades 
  • Feeling sharp, cramping or dull 
  • Going away, then coming back again (recurrent) 
  • Happening just after eating a meal 
  • Getting worse after eating fatty or greasy foods
If a gallstone blocks a duct, your child may also have some or all of these symptoms:
  • Nausea 
  • Vomiting 
  • Fever 
  • Jaundice, a yellowish tint to the skin and eyes.

Diagnosing gallbladder disease

The most common test to diagnose gallbladder disease and gallstones is ultrasound. An ultrasound machine emits sounds waves that bounce off the gallbladder and other organs to form a picture on a video monitor. Using this picture, the doctor can then look for gallstones or signs of inflammation.

There are also other techniques that can be used to look for gallstones or blocked ducts, or to check how well the gallbladder is working. Your child's doctor may ask your child to have:
  • An abdominal X-ray 
  • Cholescintigraphy (HIDA scan), which lets doctors see how well your child's gallbladder contracts 
  • An ERCP (endoscopic retrograde cholangiopancreatography), which helps doctors find and remove gallstones in the bile ducts 
  • An MRCP (magnetic resonance cholangiopancreatography), a type of MRI (magnetic resonance imaging) that takes detailed pictures of bile and the biliary tract
Your child may need blood tests, too. Blood tests may show signs of infection, obstruction, jaundice or other problems related to gallstones.

Treatment

If your child's gallstones do not cause any symptoms, treatment may not be needed. If they do, your child will need surgery to remove the gallbladder. This surgery is called cholecystectomy.

Removal of the gallbladder is a common procedure and most patients have no adverse side effects from having their gallbladder removed. If your child has undergone a cholecystectomy, the bile will simply flow from the liver directly into the intestine. Your child should be able to eat normally and continue with normal activities after having the gallbladder removed. The most common symptom after removing the gallbladder is loose stool, especially after eating a fatty meal.

At the time of surgery, we will give your child medicine to make them sleep without pain during the operation (general anesthesia).

In most cases, surgeons can remove the gallbladder using laparoscopic surgery, also called minimally invasive surgery. This means they make several small cuts (incisions) in the belly instead of one large incision (open surgery). Surgeons insert a thin, lighted tube with a camera and their surgical instruments through these small incisions. The gallbladder is removed from its attachement to the liver and removed through one of the openings.

The advantage of laparoscopic surgery is that surgeons don't have to cut through the stomach muscles and recovery time is generally much quicker.

On rare occasions, children need to have open surgery instead of laparoscopic surgery. This may be the case if your child has had other abdominal operations in the past. If so, your child's surgeon will discuss it with you prior to the operation.

During the gallbladder removal operation, the surgeon may perform a cholangiogram, a study of the bile ducts. This study is not always necessary, but it helps doctors make sure that gallstones have not fallen out of the gallbladder and into the main bile duct. If the study does show gallstones in the main bile duct, the surgeon will try to remove them. Because the bile ducts of children are usually very small, this can be very difficult to do using laparascopic techniques.

In some cases, a child may need an ERCP (endoscopic retrograde cholangiopancreatography) to remove gallstones that have passed out of the gallbladder in to the main bile duct. In an ERCP, the surgeon passes a lighted scope through the child's mouth, past the stomach and into the upper small intestine (duodenum). This way, the doctor can see the bile duct entering the intestine. Small instruments can be passed through the scope and used to remove the gallstones. By performing an ERCP, doctors may avoid having to perform a larger operation on your child.

After surgery

After laparoscopic surgery, you can expect your child to stay in the hospital for one day. After open surgery, you can expect your child to stay in the hospital for two to five days. You may need to limit your child's activity while they recover, regardless of which operation that undergo (open or laparoscopic).

Your child will be given pain medicine to make them comfortable. You'll need to keep the incisions clean and dry until they heal. The surgery team will teach you how to do this and tell you about any activity limits.

Your child may shower, but they will not be allowed tub baths or swimming for 10 days.

Children may return to school per their discretion. This usually is approximately 1 week after surgery. Physical activity and sports may resume after being seen by their surgeon (usually 2 weeks).

When to call the doctor

After your child has been treated for gallbladder problems, it is important that you carefully monitor their health. Call the doctor if your child experiences any of the following symptoms:
  • Fever greater than 101 degrees Fahrenheit 
  • Signs of infection of incision sites, including: redness, yellow or green discharge, tenderness, warmth or foul odor 
  • Vomiting, poor oral intake 
  • Jaundice 
  • Any other concerns