Gallstones in Adolescents

by Marcy Brinkley

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Gallstones can occur in children of any age, from infancy through adolescence. The risk
seems to increase with age, with 50 percent of all childhood gallstones occurring in teens
between the ages of 14 and 18. Many adolescents have silent gallstones that cause no
symptoms and require no treatment. Surgery is the treatment of choice for adolescents who
have gallstones that cause symptoms.
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Risk Factors
Adolescents may develop either cholesterol gallstones or hemolytic gallstones. Among
adolescents, the highest risk group for developing cholesterol gallstones is obese girls, but
obesity is a significant risk factor for both boys and girls in adolescence. Other risk factors
for cholesterol gallstones include family history, pregnancy, contraceptive use, chemotherapy
or a chronic illness such as cystic fibrosis. Ethnicity is also a factor, as Native Americans and
Mexican Americans are more likely to develop gallstones. Hemolytic stones, caused by the

breakdown of blood cells, are seen in nearly 50 percent of adolescents with sickle cell
disease.

Signs and Symptoms

Adolescents with gallstones may have no symptoms. If symptoms are present, adolescents
typically complain of nausea, vomiting and abdominal pain, a condition called biliary colic.
An adolescent with acute cholecystitis -- inflammation of the gallbladder that comes on
suddenly -- may have pain in the upper right area of the abdomen, fever and a swollen
gallbladder. With chronic cholecysitis, an inflammation of the gallbladder that causes
recurring episodes, the adolescent may complain of less severe attacks of abdominal pain
after eating, alternating with periods of feeling well. Gallstones in the bile duct between the
liver and the gallbladder may cause the skin and the whites of the eyes to turn yellow, a
condition called jaundice.

Diagnosis
The physical exam of an adolescent with gallstones may be normal unless a gallstone is
blocking a bile duct. The health care provider may order blood tests to determine if there's an
infection or if the liver or pancreas has been damaged. The most useful test is the abdominal
ultrasound, which can detect at least 95 percent of gallstones in the gallbladder. Abdominal
ultrasound is not as effective in identifying gallstones obstructing a bile duct so a scan, called
cholescintigraphy -- an imaging scan that follows the flow of bile -- may be needed.
Abdominal x-rays identify only about 30 percent of gallstones present and CT scans are
generally not used unless there is a concern about complications involving the main bile duct
or the pancreas.

Treatment
If the adolescent has silent gallstones that do not cause symptoms, no treatment is needed at
that time. The health care provider typically monitors the adolescent to see if symptoms
appear later. For adolescents with gallstones causing symptoms, the treatment of choice is to
remove the gallbladder using a minimally invasive technique called laparoscopic
cholecystectomy. Although a few patients continue to have symptoms after surgery, most
recover well and do not develop new symptoms. The issue of using bile acid medications in
adolescents to dissolve stones without surgery has not been resolved and is not
recommended.
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