CHOLECYSTITIS

             Acute acalculous cholecystitis is uncommon in children and is usually caused by infection. Reported pathogens include streptococci (groups A and B), gram-negative organisms, particularly salmonella and leptospira interrogans. Parasitic infestation with ascaris or Giardia lamblia may be found. Acalculous cholecystitis may rarely follow abdominal trauma or burn injury or be associated with a systemic vasculitis, such as periarteritis nodosa.

            Cholesterol cholecystitis in children most frequently affects obese adolescent girls. Cholesterol gallstones are also found in children with disturbances of the enterohepatic circulation of bile acids, including patients with ileal disease and bile acid malabsorption, such as those with ileal resection, ilael cohn disease, and cystic fibrosis. Pigment stones may also occur in these patients.

            Cholesterol gallstone formation may also seem to result from an excess of cholesterol in relation to the cholesterol-carrying capacity of micelles in bile. Supersaturation of bile with cholesterol leading to crystal and stone formation could result from decreased bile acid from an increased cholesterol concentration in bile. Other initiating factors that may be important in stone formation include gallbladder stasis, or the presence in bile of abnormal mucoproteins or bile pigments that may serve as a nidus for cholesterol crystallization.