Cholelithiasis in children with sickle-cell anemia in Dakar - Senegal

Background. - Cholelithiasis is a well recognized complication of sickte-cell anemia (SCA) because of chronic hemolysis. It is usually asymptomatic but may result in acute cholecystitis of cholangitis. The aim of this study was to assess prevalence of cholelithiasis ann its associated factors among Senegalese children and adolescents with SCR. Patients and methods. - We analyzed the follow-up records and results of systematic clinical biological and ultrasonographic examinations in 106 patients with SCA aged 11 months to 22 years (median: 10 years, 6 months), followed up in the Albert- Rover Children's Hospital (Dakar). Results. - Cholelithiasis was detected in 9.4% of the patients. Gentler; ethnic group. geographic origin and socioeconomic conditions did plot have any association with cholethiasis frequency The frequency. The youngest patient with cholelithiasis was 7 years old and prevalence of cholelithiasis increased with age. The mean age at the beginning of SCA follow-up was higher among patients with cholelithiasis. They were more frequently transfused and tended to present more frequent pain crises and other complications of SCA. We found no spontaneous clinical manifestations attributed to cholelithiasis. Nevertheless. provoked right upper quadrant pain was more frequently observed in patients with cholelithiasis. Fetal hemoglobin, steady-state hemoglobin, reticulocytes count, serum bilirubin, alkaline phostatase and transaminase levels were not significantly different in these patients, compared to the others. However, those with cholelithiasis had significantly higher mean red cell volume. Conclusion. - Prevalence or cholelithiasis appears relatively low in Senegalese patients with SCA, probably owing to the tolerance of the Senegal haplotype. Advanced age and severe chronic hemolysis are etiologic factors in evidence. We recommend systematic abdominal ultrasound at least once a year for patients older than 5 years, or when right upper quadrant pain is observed. Cholecystectomy should be performed in cases of cholelithiasis in order to prevent complications. (C) 1999 Editions scientifiques et medicale Elsevier SAS.