Cholelithiasis is defined as “the presence or formation of stones in the gall bladder”. Cholelithiasis incidence ranges from 0.15% to 0.22%.. Cholelithiasis is common throughout the adult population, affecting as many as 25 million Americans and resulting in 500,000-700,000 cholecystectomies per year.
The prevalence of Cholelithiasis has been rising in the pediatric population. Gallbladder disease is much rarer in children, with 1.3 pediatric cases occurring per every 1000 adult cases .A population-based study estimated that the prevalence of gallstones and biliary sludge in children is at 1.9% and 1.46%, respectively.2 .Pediatric patients undergo 4% of all cholecystectomies. Cholecystectomy is the procedure of choice for symptomatic children with Cholelithiasis, regardless of age. 2, 3. Cholelithiasis can occur at any age, including prenatally, but is most common during puberty. Females are at significantly higher risk, with an overall 4:1 female-to-male predominance that increases to 11 to 22.1 during adolescence.
The common causes related to predisposing factors are hemolytic disease, hepatobiliary disease, obesity, prolonged parenteral nutrition, abdominal surgery, trauma, sepsis, and pregnancy. In children, one fourth of total Cholelithiasis cases are Calcium carbonate stones, the remaining 48% of gallstones in children get Black pigment stones. They are formed when bile becomes supersaturated with calcium bilirubinate, the calcium salt of unconjugated bilirubin. Black pigment stones are commonly formed in hemolytic disorders and can also develop with parenteral nutrition. The complications of Cholelithiasis in children are similar to those in adults.2
A baby aged 5 years came with the following complaints:
Pain in the abdomen on and off, pain in the throat with recurrent fever,with multiple Gall stones.
Presenting complaints : Pain in the right hypochondria on and off for a year, shifting from right to left. Fullness of abdomen; on and off pain in the throat < by eating chocolates, which she has a great desire for.
Past history: nothing significant
Treatment history: took conventional medicine for above problem.
Family history: Her mother is suffering from Migraine.
Aversions: Nothing in particular
Bowel movements: Normal.
General physical examination & observations : Normal build and weighs 20 KGs; child is fussy in nature; on examination of throat : no congestion but chronic enlargement of tonsils.
GIT: abdomen on palpation soft, NYD
Investigations of significance: WBC: 18200, ESR: 15mm, CRP: 60mg/l, ASO: 200IU/ml,
Alkaline Phosphate: 650IU/L, SGPT 45IU/L and SGOT 37IU/L. Ultra sound Scan: Multiple stones in Gall bladder.
Provisional diagnosis: Cholelithiasis
Clinical diagnosis: Cholelithiasis, Chronic Tonsillitis,
Clinical classification: Dynamic chronic fully developed miasmatic disease
Miasmatic diagnosis: Trimiasmatic
Totality of symptoms: As shown in reportorial chart
Repertorial totality: A shown in Repertorial chart
Repertorial result and Analysis : See below
8/9/2009: Nux Vomica 200, 3 doses. Also, 15 days of Rubrum (placebo) was given.
25/09/09: No change in her complaints, 7 days Rubrum was given.
09/10/09: no change in her complaints as per the Repertorisation, Lycopodium covered 6 out of 7 symptoms. I gave Lycopodium 30 C, 3doses and 15 days of Rubrum .
24/10/09: Pain in throat reduced; appetite not improved; pain in right hypochondrium persists. Fifteen days Rubrum was given.
19/11/09 Appetite improved. Pain in right hypochondrium persists. Fullness of abdomen was slightly better. Tuberculinum 200C, 3doses were given. Also 15 days of Rubrum .
28/11 / 09: She came with pain in right upper quadrant of abdomen; bowel movement was normal, regular. Cardus marianus 6C, 2 pills twice a day for 10 days, followed by Rubrum for 20 days.
25/12/09 : Weight has increases to 21 kgs. General condition was normal. Repeated Cardus m. 6C , 2pill twice a day for 10 days followed by Rubrum for 20 days. Advised patient go for Ultra sound Scan and Liver function Test.
17/01/2010: General condition was normal. Ultra sound Scan was normal as shown below.
Liver function Test Within normal limits. Advised the father of the patient to come after 2 months for review.
Reasons for selecting the remedies:
Nux Vomica was selected, since this case had been treated conventionally and it covered five out of seven symptoms. Lycopodium was selected as it covered six out of seven symptoms and it is a right sided remedy. Tuberculinum was prescribed as well indicated remedies were not giving desired results. Carduus Marianus 6C was given as it is a very important remedy for Gall Stones. There was a lot of pressure on me, since the patient was a relative of the local gastroenterologist. There was fear of obstruction and the parents were afraid of going for surgery. For these reasons I changed the remedies frequently. However, the child got the desired cure.
Conclusion: Estimated prevalence of gallstones and biliary sludge in children is 1.9% and 1.46%, respectively.2 In children a very common presentation will be pain in right upper quadrant of abdomen. Most physicians don’t dream of this Cholelithiasis condition. In the majority of cases we can relive the pain by our homoeopathic remedies. Sometimes we may not get expected results, and only ultra sound Scan can give us the direction to proper treatment. The above case is one example in which an organopathic remedy helped to dissolve the multiple stones. In children we have to depend on only objective symptoms, as children are often not in position to give their subjective symptoms.
Acknowledgements : I thank the patient for the cooperation she has extended during the time of treatment.
Scan reports before and after treatment