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Introduction: BSD is one of the most frequent disorders affecting the gastrointestinal tract; its incidence in the adult population is above 25% for females and around 10% for males. Race and ethnicity play a major role in its development, more frequent in hispanics and native descendents. In some latinamerican countries (Chile, Bolivia, Colombia) the incidence of gallbladder cancer is the highest in the world. A high incidence of these conditions and its complications has been found in the younger population.
Objective: analyze the incidence, clinical presentation and course and prognosis of BSD in patients under 25 years.
Methods and materials
After approval of our institutional IRB a retrospective analysis of medical records of patients who underwent admission for BSD at our single institution between January 2005 and January 2011 was performed. 5377 patients were admitted for BSD and/or its complications, being 591 (10.99 %) under 25 years with a median age of 20 (range 12/24). 449 ( 76 %) were female and 9 patients were pregnant at the time of clinical onset of symptoms. Our guidelines included a minimal invasive approach for treatment of illness and complications.
Results: 457 ( 77.33 %) patients were admitted for elective surgery (laparoscopic cholecystectomy with intraoperative cholangiogram and/or CBD exploration) and the previous medical history included: acute pancreatitis in 56 (12.25 %), pancreatic pseudocysts in 3 (0.65 %), acute cholecystitis in12 (2.62 %), common bile duct stones in 32 (7.00%). Laparoscopic cholecystectomy was completed in 433 (94.74%), intraoperative cholangiography was achieved in 397 cases (86.66%). The remaining 24 patients required conversión through a right subcostal incisión due to: Mirizzi’s síndrome (3), cholecystocolonic fistula (2), cholecystoduodenal fistula (2), CBD multiple stones, intense adhesions, intraoperative complications (bleeding, liver laceration). The other 134 (22.67 %) were admitted as emergency cases. The initial diagnosis was: acute cholecystitis (75), acute colangitis (55), liver abscess (4). The treatment was the following: laparoscopic cholecystectomy 75, ERCP with papillotomy and stone removal, and percutaneous drainage. Postoperative complications were the following:surgical site infection (5%), intraabdominal collections (2%), retained CBD stones (1%). No bile duct injuries were registered.
Conclusions: the spectrum of BSD, its progress and complications in the young population imposes a prompt diagnosis and surgical treatment in order to correct symptoms, prevent complications and avoid sequelae and disability. Pregnant patients poises a clinical management and challenge, mainly in the first trimester pregnancies.