CHOLELITHIASIS IN SICKLE CELL ANEMIA

It is always difficult to argue for elective surgery in patients who already have a shortened life expectancy and who have no symptoms that can be convincingly attributed to their disease. Just this situation exists when cholelithiasis complicates sickle cell anemia. A review of recent experience suggests that at least one third of those over the age of ten with homozygous sickle cell disease have gall stones and pathologic findings of chronic cholecystitis, but less than 10 per cent have symptoms or signs which can be attributed to the biliary tract or relieved by cholecystectomy. However, because it is not possible to predict in which patients complications of cholelithiasis will develop, and because the manifestations of such complications may be virtually impossible to diagnose in the presence of sickle cell anemia, it seems advisable to consider elective cholecystectomy in all patients with sickle cell anemia and cholelithiasis. There is no evidence that surgical mortality in these patients is increased or that stones recur despite persistence of the metabolic defect. The collection of larger series would serve to confirm or disprove these expectations. © 1968.