Aims To highlight the difficulty in making the diagnosis and the lack of clear guidance for managing gallstone diseases in children using four cases that were diagnosed on our unit. Gallstone disease in children is rare. Its presentation can vary from asymptomatic to classic symptoms, making the diagnosis difficult. Recent evidence suggests that the incidence of gallstone disease is rising. However, this may be due to the increasing use of sonography and has meant that more incidental cases of gallstones are being picked up. Guidance on the most appropriate management in children is lacking.

Method We identified four children with gallstones on our paediatric ward. A literature review was performed to consider any guidance for the appropriate management of the disease.

Results Four children aged six months to 12 years old, attending our paediatric ward were found to have gallstones. They were picked up incidentally on routine abdominal ultrasound for other medical reasons but two of the children had symptoms that could be attributed to their gallstones. However for three children, the stones disappeared on repeat ultrasound, suggesting that they may have been ‘sludge balls’ in the gallbladder, likely secondary to acute dehydration from being ill.

A review of the literature suggested that if gallstones are found in children, further investigations are recommended into common causes of the disease, such as haemolytic disorders. None of our children had any underlying disease that could predispose to gallstones but three of our patients had risk factors in their medical history including, cardiac surgery, total parental nutrition and Cefotaxime use. The consensus on management is to consider watching and waiting if the child is asymptomatic or symptoms are mild. There is limited evidence on the use of Ursodeoxycolic acid for the removal of gallstones, though this was prescribed in two of our children.

Conclusion Our cases demonstrate how gallstones are often diagnosed and how decisions on their management are reached. The general consensus is to consider watching and waiting if they are asymptomatic, as gallstone disease has been known to spontaneously resolve in children.