Dirk Schaper (Klinik für Kinderchirurgie Krankenhaus St. Elisabeth und St. Barbara Halle/S.)  

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15 Years  

Male  

Abdomen-Other and unknown  

metabolic  

15 year old boy presented with known history of hereditary spherocytosis. Initially nephrologic workup for hematuria. During sonography, the pathology was found. Patient was otherwise without complaints.  

Hereditary spherocytosis is the most frequent hereditary hemolytic anemia in central europe. Due to the spheric form of the erythrocytes, hemolysis and increased break down of erythrocytes in the spleen occurs. The increased accumulation of bilirubin leads to development of bilirubin gallstones.  

<- view Ultrasound 1

Ultrasound 1: Right upper quadrant, echogenic, partially echo mixed 18x36mm large structure in an echo-free environment subhepatic, with irregular surface.





<- view Ultrasound 2

Ultrasound 2: Dito, longitudinal view with significantly irregular surface.





<- view Ultrasound 3

Ultrasound 3: 8 months later, sharply demarkated structure with clear shadowing 24x37mm.





<- view Ultrasound 4

Ultrasound 4: Same structure with good mobility upon changing the patient's position.


 

Total constellation (Consens)  

Cholelithiasis, Hemobilia  

So far no treatment, but waiting and observing. A solel splenectomy should prevent the development of gallstones. In the case of coexisting gallstones at time of splenectomy, the simultaneous cholecystectomy is discussed. Continuous clinical and sonographic follow up exams are recommended, especially if the stones are small or the gallbladder wall appears thickened.  

N/A  

N/A  

1. Medline:
Guidlines for the diagnosis and management of hereditary spherocytosis.
B.Bolton-Maggs,Stevens, R.F., N.J.Dold, G.Lamont,P.Tillensor,P.H., M.J.King
BJ of Hematology 126 (2004) 455-474  

gallstone, gallbladder stone, cholelithiasis, hereditary, spherocytosis, hereditary spherocytosis, bilirubin, bilirubin stone, bilirubin gallbladderstone, child, childhood, pediatric radiology  

Dirk Schaper. Asymptomatic Solitary Gallbladder Stone in Hereditary Spherocytosis. PedRad [serial online] vol 5, no. 11.
URL: www.PedRad.info/?search=20051128163422