Digestive and Gastrointestinal Conditions

Gallstones

What are gallstones?

Gallstones are small, stone-like objects that form when the liquid in the gallbladder hardens. This liquid is called bile. It helps the body digest fats.

The liver makes bile, and the gallbladder stores it until the body needs it. Then the gallbladder contracts and squeezes bile out into the intestines. A series of tubes connects the liver, gallbladder and intestines. The tubes leaving the liver are called the hepatic ducts. The tube leaving the gallbladder is called the cystic duct. They combine to form the common bile duct, which goes to the intestines.

Bile contains water and several solids: cholesterol, fats, salts and proteins. It also contains bilirubin, a yellowish pigment. Usually gallstones are made mostly of cholesterol. Some are made of bilirubin.

If gallstones get lodged in a duct, they can block the flow of bile. This can cause the duct or the gallbladder to swell. Ongoing blockage can damage the liver, the gallbladder or the pancreas. Blockage can lead to infection, too. Organ damage and infection can be serious problems.

Gallstones in children

Gallstones are not as common in children as they are in adults. But some children do get gallstones. Most often, there is no specific underlying cause for gallstones in children. But some factors can put kids at increased risk for them:

  • Having certain inherited blood problems, such as sickle cell disease or spherocytosis
  • Being obese
  • Having a family history of gallstones
  • Taking certain medicines

Gallstones at Seattle Children’s

  • We have treated many children with gallstones at Seattle Children’s. Our surgeons have extensive experience in performing the most common operation to remove the gallbladder, called laparoscopic cholecystectomy (pronounced koh-leh-sist-EKT-uh-mee). We also have extensive experience in dealing with the possible complications of gallstone disease, such as problems with the liver or pancreas.

  • When you come to Seattle Children’s, you have a team of people to care for your child before, during and after surgery. Along with your child’s surgeon, you are connected with nurses, dietitians, child life specialists and others. We work together to meet all of your child’s health needs and help your family through this experience.

  • Since 1907, Seattle Children’s has been treating children only. Our team members are trained in their fields and also in meeting the unique needs of children. For example, the doctors who give your child anesthesia are board certified in pediatric anesthesiology. This means they have extra years of training in how to take care of kids. Our child life specialists know how to help children understand their illnesses and treatments in ways that make sense for their age.

Symptoms of Gallstones

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.

    It is difficult for most children younger than about 9 or 10 years old to pinpoint their pain. They may seem vague about where they hurt. But some older children or young adults may describe their pain as:

    • 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 Gallstones

Ultrasound exam

Doctors often diagnose gallstones using ultrasound exams. An ultrasound machine emits sound waves that bounce off the gallbladder and other organs to form a picture on a video monitor. The doctor can look for gallstones in this picture.

Other body imaging

Sometimes doctors use other imaging techniques 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
  • A cholescintigraphy (pronounced koe-leh-skin-TIG-ruh-fee), or HIDA scan, which lets doctors see how well your child’s gallbladder contracts
  • An ERCP (endoscopic retrograde cholangiopancreatography, pronounced koe-LAN-jee-oh-PAN-kree-ah-TOG-rah-fee), 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

Lab work

Your child may need blood tests, too. Blood tests may show signs of infection, obstruction, jaundice or other problems related to gallstones.

Treating Gallstones

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

It’s OK not to have a gallbladder. If your child doesn’t have a gallbladder, 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. Most children do not have this problem.

  • At the time of surgery, we will give your child medicine to make them sleep without pain during the operation (general anesthesia). Removing the gallbladder takes about 1 to 2 hours. Your child will be in the recovery room for another hour.

    Less invasive surgery

    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. Then they snip the gallbladder free and remove it through one of the openings.

    The advantage of laparoscopic surgery is that surgeons don’t have to cut through the stomach muscles. Children recover faster.

    Open surgery

    On rare occasions, children need to have open surgery (one large incision) 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.

  • 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 laparoscopic techniques.

    Removing gallstones outside the gallbladder

    In some cases, a child may need an ERCP (endoscopic retrograde cholangiopancreatography, pronounced koe-LAN-jee-oh-PAN-kree-ah-TOG-rah-fee) to remove gallstones that have fallen out of the gallbladder. 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. An ERCP often helps doctors avoid doing a larger operation on your child. If your child needs an ERCP, it most likely will be done on a different day from the gallbladder removal surgery.

  • After laparoscopic surgery, you can expect your child to stay in the hospital for 1 to 2 days. Once your child is home, you may need to limit activity for several days.

    After open surgery, you can expect your child to stay in the hospital for 2 to 7 days. You may need to limit your child’s activity for several weeks while they recover.

    In either case, we will give your child 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.

    About 2 to 3 weeks after surgery, your child will need to see the surgeon for a follow-up visit. The surgeon will make sure the incision is healing and your child is recovering well.