Cholelithiasis, cholecystitis, and common bile duct stones.

Cholecystitis and cholelithiasis are being recognized with increasing frequency in infancy, childhood, and adolescence. Hematologic disorders account for a large proportion of cases; however, in most cases the etiology is uncertain. Infants and children are noted with stones in association with total parenteral nutrition, prolonged fasting, or ileal resection. Biliary dyskinesia, a disorder of impaired gallbladder contractility, is being recognized with increased frequency in late childhood and teenage years. Spontaneous stone resolution is frequently noted in infancy, and a period of observation is appropriate in the absence of symptoms. Laparoscopic cholecystectomy is the procedure of choice for symptomatic cholelithiasis and biliary dyskinesia. Common bile duct stones are unusual in children, occurring in 2% to 6% of children with cholelithiasis, often in association with obstructive jaundice and pancreatitis. Endoscopic retrograde cholangiography with stone extraction performed before or after laparoscopic cholecystectomy is the procedure of choice in this setting.