Acquired biliary diseases in children

Acquired biliary diseases are far less common in children than in adults and include gallstones, acalculous cholecystitis, biliary dyskinesia, primary sclerosing cholangitis (PSC) and benign biliary strictures. Gallstones have been increasingly diagnosed in children in recent years mainly due to increasing use of ultrasonography. The etiologies of cholelithiasis are hemolytic (20%–50%), other known etiology (30%–40%) such as total parenteral nutrition, ileal disease, congenital biliary diseases and idiopathic (20%). Spontaneous resolution of gallstones is frequent in infants and hence a period of observation is recommended even for choledocholithiasis. Children with gallstones can present with typical biliary symptoms (50%), nonspecific symptoms (25%), be asymptomatic (20%) or complicated (5%–10%). Cholecystectomy is useful in children with typical biliary symptoms but is not recommended in those with non-specific symptoms. Prophylactic cholecystectomy is recommended in children with hemolytic disorders. Biliary dyskinesia is characterized by biliary colic without the presence of gallstones. Management is controversial. In PSC immunosuppressive therapy helps children with PSC with autoimmune hepatitis features.