Upper and Lower GI Surgery
Gallstones
Gallstones are stone-like formations found in the gallbladder. They are rare, occurring roughly in 1% of children. There are several different causes of gallstones, and they can be made up of different substances including cholesterol (which may be related to diet and lifestyle). Some children with blood problems can develop gallstones made of blood cell pigments. There are also calcium, protein and black pigment stones. Gallstones can vary significantly in size, shape and consistency, and they can be present without causing any problems at all. The main symptom of gallstones is tummy pain; sometimes it can be severe enough to cause nausea and vomiting. It can also be associated with fever if there is an infection in the gallbladder or tubes connecting it to the gut.
Gallstones can become stuck in the tubes to the gut, and can cause symptoms such as a yellow tinge to the skin (jaundice), pale faeces and dark urine. Stones may also cause blockage of the pancreas duct, which can cause inflammation of the pancreas (pancreatitis). Pancreatitis causes severe pain, fever and jaundice and is a serious condition that requires urgent medical care.
An ultrasound scan is commonly undertaken and blood tests might be required. Other types of scans such as magnetic resonance imaging (MRI) scans with magnetic resonance cholangiopancreatography (MRCP) may also be useful. If gallstones are not causing any problems, they do not necessarily need to be treated and dietary changes might help. However, most gallstones will cause symptoms. Surgery consists in removing the gallbladder (cholecystectomy) and is usually carried out using keyhole surgery (laparoscopically). The majority of children live a normal life without a gallbladder, with few long term effects.
Rectal prolapse
The rectum is the lower portion of the large intestine. Rectal prolapse occurs when the lining of the rectum protrudes through the anus. This can occur because the muscles of the pelvis become weakened from issues including chronic constipation with straining while going to the bathroom, or chronic diarrhoea. You will notice a dark red mass protruding from the anus (particularly when your child is straining), sometimes accompanied by blood or mucus, that can be easily pushed back in. Rectal prolapse isn't usually painful, but it can cause discomfort. Other symptoms may include soiling, feeling of fullness or of not being able to completely empty the bowels, itching and/or irritation.
Mild cases of rectal prolapse can be treated by your GP who may prescribe a stool softener, and increasing dietary fibre to improve regular bowel movements. In the vast majority of cases, the prolapse will resolve once the constipation is under control. It is exceptionally rare that children will require surgical intervention.
Haemorrhoids
Haemorrhoids rarely occur in children and usually are not serious; they generally go away on their own or with medical management. Surgery is very rarely required in children.
Haemorrhoids in children are typically caused by constipation. Poor diet and exercise habits can cause the child’s stools to become dry and hard, thus making them difficult to pass. The result is that the child may strain to have a bowel movement and this puts stress on the veins in the anus and rectum and therefore haemorrhoids may develop.
The most effective approach is to change your child’s diet and lifestyle habits. Since constipation is the biggest cause of haemorrhoids in children, avoiding constipation is the most important thing you can do to prevent haemorrhoids.
Adding fibre and plenty of fluids to your child’s diet is the first step towards preventing constipation. Exercise is another lifestyle habit that can be introduced into your child’s daily routine to help prevent constipation and potentially haemorrhoids. A variety of medications are also available to treat your child’s constipation; Dr Pacilli will be able to advise you regarding the best regimen of medications, depending on the severity of your child’s constipation.
Disclaimer: Please note that the information contained on this website should not be used for the diagnosis or treatment of any medical condition. If you have specific questions about how the information relates to your child, please ask your doctor.