A Case of Paediatric Cholelithiasis

Dr Ram kumar Abstract: Gallstones are a major public health problem in all developed countries. Although gallbladder disease had traditionally been considered an adult condition, the prevalence has been rising in the pediatric population. A baby, aged six years, came in with multiple Gall stones and was treated successfully with Pulsatilla. Treatment was guided by ultra sound scan of abdomen before and after treatment. It is an evidenced based Homoeopathic treatment. Key words: Homoeopathy/ Cholelithiais/Pulsatilla Introduction:
Cholelithiasis is defined as the presence or formation of stones in the gall bladder.Cholelithiasis incidence ranges from 0.15% to 0.22%.. Cholelithiasis is common throughout the adult population, affecting as many as 25 million Americans and resulting in 500,000-700,000 cholecystectomies per year.The prevalence of Cholelithiasis has been rising in the pediatric population. Gallbladder disease is much rarer in children, with 1.3 pediatric cases occurring per every 1000 adult cases .A population-based study estimated that the prevalence of gallstones and biliary sludge in children is at 1.9% and 1.46%, respectively.2 .Pediatric patients undergo 4% of all cholecystectomies. Cholecystectomy is the procedure of choice for symptomatic children with Cholelithiasis, regardless of age. 2, 3.Cholelithiasis can occur at any age, including prenatally, but is most common during puberty. Females are at significantly higher risk, with an overall 4:1 female-to-male predominance that increases to 11 to 22.1 during adolescence. Factors affecting the increasing incidence of cholelithiasis in children include increased detection with increased use of ultrasonography, as well as the growing obesity epidemic. The common causes related to predisposing factors are hemolytic disease, hepatobiliary disease, obesity, prolonged parenteral nutrition, abdominal surgery, trauma, sepsis, and pregnancy. In children, one fourth of total Cholelithiasis cases are Calcium carbonate stones, the remaining 48% of gallstones in children get Black pigment stone. The complications of Cholelithiasis in children are similar to those in adults.2 As in adults, treatment for simple cholelithiasis is largely symptomatic, and laparoscopic cholecystectomy remains the criterion standard in treatment for symptomatic cholelithiasis. Homeopathic medicines will help in possibly dissolving the stones when the stones are of a smaller size. Homeopathy medicines are effective in alleviating pain as well as chronic inflammation of gallbladder (cholecystitis) associated with the condition. Homeopathy also helps to control further stone production activity. If the stones are bigger, multiple and impacted, it may require surgical intervention.

Case Study A Femalechild, 6.5 years old, was suffering from recurrent upper abdominal pain along with nausea and vomiting < oily foods which she craves, for the last one month. Her pain at times incapacitated her and prevented her from carrying out her day-today activities. Past medical history reveals Giant urticaria and family history of diabetes and Bronchial asthma.Unable to bear the pain any longer, she was taken to a government hospital (DR BSAH,Opd,Delhi) where she was diagnosed with gallstones and advised surgery.Parents feared surgery in young age and resorted to allopathic medications that provided only temporary relief.After having tried various treatment options in vain, on their friends recommendation they came to our Homoepathic unit. Ultrasonography (dated-21/6/2012) and the reports revealed multiple mobile stones 4-6mm in size and the largest measuring 10 mm respectively. The patient was given Pulsatilla-30/tds/2days (dated-14/07/2012), as a constitutional remedy along with Nat.sulph-6x/tds for 2weeks.As the treatment progressed; she found a considerable reduction in the frequency and severity of her pain. Her abdominal bloating and nausea reduced, enabling her to resume her daily activities. Pulsatilla -200/tds/2days along with Nat.sulph-6x/tds for 2weeks was given following an episode on 14/8/12.The patient was asymptomatic for almost 3months, after which the repeat scan done (dated-10/11/2012) showed no significant abnormality/no calculus. Discussion: A Homeopathic medicine, when started at the right time during the course of the disease helps to avoid complications as well as surgery in this young child. It also helps to provide immediate pain relief without any side-effects, besides also reducing the chances of recurrence of the pain. Homeopathic medicines, thus, facilitate the dissolution of gallstones. In cases of Large and multiple stones, homeopathy has no curative role to play.

References:
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http://pedsinreview.aappublications.org/content/30/9/368.extract http://emedicine.medscape.com/article/927522-overview#aw2aab6b2b5aa http://pedsinreview.aappublications.org/content/11/9/268.

Hail Homoeopathy, DR K.RAM KUMAR M.D(Hom),Senior medical officer,DR BSAH(H),Dte of ISM & Homoeopathy,Govt of NCTof Delhi.