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High rates of recurrent biliary tract obstruction in children with sickle cell disease

Authors

  • Martha O. Amoako MD,

    1. Johns Hopkins University School of Medicine, Baltimore, Maryland
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  • James F. Casella MD,

    1. Division of Pediatric Hematology, Dept of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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  • John J. Strouse MD, PhD

    Corresponding author
    1. Division of Pediatric Hematology, Dept of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
    2. Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
    • Ross 1125, 720 Rutland Ave, Baltimore, MD 21205.
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  • Conflict of interest: Nothing to declare.

Abstract

Background

Individuals with sickle cell disease (SCD) have an increased risk of cholelithiasis from bilirubin stones. Symptomatic biliary tract disease (BTD) includes acute and chronic cholecystitis, obstruction of the common bile duct (CBD), cholangitis, and gallstone pancreatitis. Cholecystectomy is the main treatment strategy for symptomatic patients; however, the prevalence of recurrent BTD following cholecystectomy has not been systematically evaluated. We conducted a retrospective cohort study to describe the recurrence of BTD after cholecystectomy and characterize risk factors for recurrent disease.

Procedure

We identified patients <22 years of age who presented to the Johns Hopkins Children Center with symptomatic BTD from July 1993 to June 2008.

Results

We identified 56 patients with a total of 76 episodes of symptomatic BTD (median age at first event 15.9, range 4.6–21.5 years). Eleven of the 56 patients (19.6%) had at least one episode of recurrent symptomatic BTD (median follow-up of 5.3 years). Baseline characteristics were similar between the patients with a single episode of BTD and those with recurrent BTD.

Conclusions

These results demonstrate that recurrent BTD is a frequent complication of SCD (20% by age 4 years) and often presents as CBD obstruction by stone, despite cholecystectomy. In our cohort, recurrence was not associated with age at first episode, baseline total bilirubin, gender, or genotype of SCD. Pediatr Blood Cancer 2013; 60: 650–652. © 2012 Wiley Periodicals, Inc.

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