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Cholelithiasis in sickle cell anemia

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      Abstract

      It is always difficult to argue for elective surgery in patients who already have a shortened life expectancy and who have no symptoms that can be convincingly attributed to their disease. Just this situation exists when cholelithiasis complicates sickle cell anemia. A review of recent experience suggests that at least one third of those over the age of ten with homozygous sickle cell disease have gall stones and pathologic findings of chronic cholecystitis, but less than 10 per cent have symptoms or signs which can be attributed to the biliary tract or relieved by cholecystectomy. However, because it is not possible to predict in which patients complications of cholelithiasis will develop, and because the manifestations of such complications may be virtually impossible to diagnose in the presence of sickle cell anemia, it seems advisable to consider elective cholecystectomy in all patients with sickle cell anemia and cholelithiasis. There is no evidence that surgical mortality in these patients is increased or that stones recur despite persistence of the metabolic defect. The collection of larger series would serve to confirm or disprove these expectations.
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      References

        • Diggs L.S.
        • Ching R.E.
        Pathology of sickle cell anemia.
        Southern M. J. 1934; 27: 839
        • Green T.W.
        • Conley L.C.
        • Berthrong M.
        The liver in sickle cell anemia.
        Bull. Johns Hopkins Hosp. 1953; 92: 99
        • Song Y.S.
        Hepatic lesions in sickle cell anemia.
        Am. J. Path. 1957; 33: 331
        • Weens H.S.
        Cholelithiasis in sickle cell anemia.
        Ann. Int. Med. 1945; 22: 182
        • Tomlinson W.J.
        Abdominal crises in uncomplicated sickle cell anemia: a clinico-pathologic study of 11 cases with a suggested explanation of their cause.
        Am. J. M. Sc. 1945; 209: 722
        • Mintz A.A.
        • Church G.
        • Adams E.D.
        Cholelithiasis in sickle cell anemia.
        J. Pediat. 1955; 47: 171
        • Jordan R.A.
        Cholelithiasis in sickle cell disease.
        Gastroenterology. 1957; 33: 952
        • Campbell Jr., E.H.
        Acute abdominal pain in sickle cell anemia.
        Arch. Surg. 1935; 31: 607
        • McGavack T.H.
        • Nussbaum C.C.
        Skin manifestations of sickle cell anemia.
        Urol. & Cutan. Rev. 1942; 46: 194
        • Grover V.
        The clinical manifestations of sickle cell anemia.
        Ann. Int. Med. 1947; 26: 843
        • Diggs L.W.
        Sickle cell crises.
        Am. J. Clin. Path. 1965; 44: 1
        • Ferguson A.D.
        • Scott R.B.
        Studies in sickle cell anemia. XII. Further studies on hepatic function in sickle cell anemia.
        J. Dis. Child. 1959; 97: 418
        • Hilkovitz G.
        • Jacobson A.
        Hepatic dysfunction and abnormalities of the serum proteins and serum enzymes in sickle cell anemia.
        J. Lab. & Clin. Med. 1961; 57: 856
        • Bogoch A.
        • Casselman W.G.B.
        • Margolies M.P.
        • Bockus H.L.
        Liver disease in sickle cell anemia. A correlation of clinical, biochemical, histologic and histochemical observation.
        Am. J. Med. 1955; 19: 538
        • Owen D.M.
        • Aldridge J.E.
        • Thompson R.B.
        An unusual hepatic sequela of sickle cell anemia; a report of five cases.
        Am. J. M. Sc. 1965; 249: 175
        • Wade F.A.
        Sickle cell crisis resembling obstructive (cholangiolar type) jaundice. Report of a case and review of the literature.
        Virginia M. Month. 1960; 87: 474
        • Klion F.M.
        • Weiner M.J.
        • Schaffner F.
        Cholestasis in sickle cell anemia.
        Am. J. Med. 1964; 37: 829
        • Bedell H.
        • Paley S.S.
        • Evans F.G.
        Virus hepatitis complicating sickle cell anemia.
        New York J. Med. 1951; 51: 1944
        • Meyers F.
        • Lam K.B.
        • Ticktin H.E.
        Viral hepatitis complicating sickle-cell anemia.
        Med. Ann. District of Columbia. 1963; 32: 55
        • Wruble L.D.
        • Kalser M.H.
        • Jones R.H.
        • Vloedman D.
        • Bachorik P.
        Jaundice; value of five-day steroid test in differential diagnosis.
        J.A.M.A. 1966; 195: 184
        • Glenn F.
        Chronic and acute cholecystitis and common duct stone.
        Am. J. Gastroenterol. 1965; 44: 232
        • Braasch J.W.
        • Wheeler W.M.
        • Colcock B.P.
        Acute cholecystitis.
        Surg. Clin. North America. 1964; 44: 707
        • Carraway B.M.
        • Campbell E.S.
        The management of cholecystitis and cholelithiasis.
        J.M.A. Alabama. 1964; 33: 257
        • Ahrens W.E.
        Gall bladder disease in children.
        in: 2nd. ed. Clin. Proc. Child. Hosp.13. 1957: 94
        • Easton J.C.
        • Wright P.M.
        Cholelithiasis complicating sickle cell anemia.
        J. Dis. Child. 1957; 93: 87
        • Schaefer B.F.
        Sickle cell anemia and cholelithiasis.
        Med. Ann. District of Columbia. 1942; 11: 392
        • Appleman R.M.
        • Priestley J.T.
        • Gage R.P.
        Cholelithiasis and choledocholithiasis; factors that influence relative incidence.
        in: 2nd. ed. Proc. Staff Meet. Mayo Clin.39. 1964: 473
        • Meyer K.A.
        • Capos N.J.
        • Mittelpunkt A.I.
        Personal experiences with 1,261 cases of acute and chronic cholecystitis and cholelithiasis.
        Surgery. 1967; 61: 661
        • Lind J.
        Surgical indications in cholelithiasis; prophylactic cholecystectomy elucidated on the basis of longterm follow-up in 526 non-operated cases.
        Ann. Surg. 1960; 151: 153
        • Wenckert A.
        • Robertson B.
        The natural course of gallstone disease; eleven-year review of 781 nonoperated cases.
        Gastroenterology. 1966; 50: 376
        • Shapiro N.D.
        • Poe M.F.
        Sickle cell disease. An anesthesiological problem.
        Anesthesiology. 1955; 16: 771
        • Browne R.A.
        Anaesthesia in patients with sickle cell anaemia.
        Brit. J. Anaesth. 1965; 37: 181
        • Gilbertson A.A.
        Anaesthesia in West African patients with sickle cell anaemia, haemoglobin SC disease, and sickle-cell trait.
        Brit. J. Anaesth. 1965; 37: 614
        • Kimmelstiel P.
        Vascular occlusion and ischemic infarction in sickle cell disease.
        Am. J. M. Sc. 1948; 216: 11
        • Sethi R.S.
        Surgical management of acute cholecystitis.
        Arch. Surg. 1961; 82: 366