Cholecystectomy and cholelithiasis in sickle cell anemia
B. S. Malone and S. L. Werlin
Department of Pediatrics, Medical College of Wisconsin, Milwaukee.
Elective cholecystectomy was performed on 12 children (eight male and four
female; age range, 4 to 19 years; and mean age, 11.2 years) with abdominal
pain that was related to gallstones. Seven patients had jaundice, six had
nausea, five had fat intolerance, and three had biliary colic. Two simple
transfusions (10 mL/kg of packed red blood cells), designed to decrease the
hemoglobin S content to less than 30% and to increase the total hemoglobin
level to greater than 100 g/L, were given preoperatively two to three weeks
apart. A third transfusion was given on the day before surgery if the total
hemoglobin level was less than 100 g/L. The preoperative mean hemoglobin S
content was decreased from 88% to 31%, and the mean total hemoglobin level
was raised to 122 g/L. There were no preoperative or intraoperative
complications. Post-operatively, no patients developed complications that
were related to sickle cell anemia. Hospitalization averaged 6.3 days.
Recurrent abdominal pain resolved shortly after surgery in all patients.
With proper preoperative transfusions, elective cholecystectomy is safe in
children with sickle cell anemia. Elective cholecystectomy should be
recommended at the time of diagnosis of cholelithiasis.
