Eosinophilic cholecystitis in children: Case series

Introduction: Eosinophilic cholecystitis (EC) is rarely seen in the pediatric population. Most of the available literature comes from adult patients, while only anecdotal cases have been reported in children.

Objective: To describe the clinical course, management, and outcomes of all EC cases treated at a children's hospital.

Material and methods: All cholecystectomy specimens obtained between 2011 and 2017 were retrospectively reviewed. EC was diagnosed when more than 90% of the inflammatory cells in the gallbladder wall were eosinophils, whereas lymphoeosinophilic cholecystitis (LEC) was diagnosed when the percentage of eosinophils was between 50 and 90. We analyzed all clinical aspects of patients with EC and LEC.

Results: We identified and reviewed 134 cholecystectomy specimens. Of them, 8 (6.0%) were classified as EC, and 3 (2.2%) as LEC. The mean age at presentation was 12.6 (2-17) years. The female-to-male ratio was 1.5/1. One patient had a history of hereditary spherocytosis, and 3 patients had systemic eosinophilia. All patients presented with clinical and radiological signs of acute cholecystitis and underwent cholecystectomy. Acute cholecystitis was confirmed by histopathology in all cases. All cases of EC and LEC had cholelithiasis. None of the patients required additional treatment. All patients recovered uneventfully.

Conclusions: EC is rarely seen in children, it does not have a specific clinical presentation, and it is always associated with cholelithiasis. The diagnosis is made postoperatively by histopathology. All patients in our study presented with acute cholecystitis.

Type of study: Retrospective review.

Level of evidence: Level IV.