In recent years cholelithiasis has been on the rise among infants and children, partly because of improved diagnostic modalities, but also because of an increased awareness of emerging comorbidities, such as childhood obesity, and other associated risk factors. Pigment stones are the commonest type of gallstones in children, without recognizable predisposing factors in infants or secondary to a predisposing disease such as chronic hemolysis and ileal disease. In adolescents, idiopathic cholesterol gallstones account for the majority, just like in adults. Gallbladder stones are found in 80% to 90% of cases and common bile duct stones in 10% to 20% of cases. When common bile duct stones are found, a choledocal cyst with anomalous pancreatobiliary duct junction needs to be excluded. Cholecystectomy is not indicated for silent gallstones, except in children with a predisposing disease such as chronic haemolysis. Treatment of common bile duct stones includes interventional radiologic, endoscopic or surgical procedures. In children without a predisposing disease or no residual gallstones indicating a cholecystectomy, conservative management may be proposed in specialised centres, especially for infants.
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