A Case of Paediatric Cholelithiasis treated with Homoeopathy

Prof G R Mohan

M D (Hom) PG dip (Env Stud)

Abstract:

Introduction: Gallstones are a major public health problem in all developed countries. Although gallbladder disease had traditionally been considered an adult condition, the prevalence has been rising in the pediatric population. Baby aged 5year came with multiple Gall stones was treated successful with Lycopodium and Carduus Marianus.   Treatment was guided by ultra sound scan of abdomen before and after treatment. It is an Evidenced based Homoeopathic treatment.

Key words: Cholelithiasis, Homoeopathy,

Introduction:

Cholelithiasis is defined as “the presence or formation of stones in the gall bladder”. Cholelithiasis incidence ranging 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 Cholelithiasis prevalence 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%, respectively²_.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, remaining 48% of gallstones in children belongs to 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 Case: Baby aged 5year came with following complaints

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 since a year shifting from right to left, fullness of abdomen, on and off pain in the throat < by eating Chocolates, she has great desire to eat.

Past history: nothing particular

Treatment history: took conventional medicine for above problem.

Family history: mother is suffering from Migraine.

Personal history:

Appetite: Normal

 Thirst:  normal

 Desires: Chocolates

 Aversions: - Nothing Particular

 Bowel movements: Normal.

 Urine: normal

 Sleep: normal

General physical examination & observations : normal built with 20 KGs; child is fussy in nature,  on examination of throat : no congestion only chronic enlargement of tonsils.

Systemic examination:

CVS:   NYD

RESP: NYD

CNS: NYD

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/Land 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: A shown in reportorial chart

Repertorial totality: A shown in Repertorial chart

Repertorial result:

Analysis of repertorial result:

Susceptibility: Moderate

Reasons for selecting the remedy:

Reasons for selecting the remedy:

8/9/2009: Nux Vomica 200,3doses was given and 15 days Rubrum 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 7 out of six symptoms, I gave   Lycopodium 30 C 3doses were given, 15 days Rubrum was given.

24/10/09: pain in throat reduced, appetite no improvement, pain right hypochondrium was persisting, 15 days Rubrum was given

19/11/09   appetite improved. Pain right hypochondrium was persisting, fullness of abdomen was slightly better, Tuberculinum 200C, 3doses were given, 15 days Rubrum was given.

28/11 / 09 she came with pain in right upper quadrant of abdomen, bowel movement was normal, regular. Cardus M 6C, 2pill twice a day for 1O days followed by Rubrum 20 Days,

25/12/09 :  Weight has increases to 21 kgs, General condition was normal,  repeated  Cardus M 6C , 2pill twice a day for 1O days followed by Rubrum 20 Days advised them to go for  Ultra sound Scan,  Liver function Test

17/01/2010: General condition was normal Ultra sound Scan was normal as shown below.

Liver function Test Within normal limits. Advice the father of the patient to come after 2 months for review.  

Reasons for selecting the remedies:

Nux Vomica was selected as case has come from conventional system of treatment; it has covered five out of seven symptoms. Lycopodium  was selected as  it  has covered  six  out of seven symptoms. It is a right sided remedy ,Tuberculinum was prescribed  as well indicated remedies are not giving desired results, Carduus Marianus 6C was given as it is a very important remedy for Gall Stones , there was lot of pressure on me as said  patient was relative of  local Gastroenterologist , there was fear of obstruction, parents were afraid of  going for Surgery. For this reasons  I have changed the remedies frequently. But  child got desired cure.

Conclusion: estimated the prevalence of gallstones and biliary sludge in children at 1.9% and 1.46%, respectively.² in children very common presentation will be pain in right upper quadrant of abdomen, most of the Physicians don’t dream of this Cholelithiasis condition. In majority of cases we can relive the pain by our homoeopathic remedies. Sometimes we may not get expected results, only ultra sound Scan can give us the direction to proper treatment. The above case is one example, an organopathic remedy helped to dissolve the multiple stones. In children we have depend on only objective symptoms only as children are not in position to give their subjective symptoms.

*** full length article is published in homoeopathy 4 everyone,vol 8, issue 11,2011 Nov,(hpathy.com)