although the indications for cholecystectomy in the presence of polypoid lesions in adults have been established , they remain to be clearly defined in children because of the limited experience .
we report an unusual case of a polypoid lesion of the gallbladder in an adolescent boy , which was successfully treated by laparoscopic cholecystectomy .
a 14-year - old male presented with a four - month history of recurrent right upper quadrant abdominal pain . the initial episode , which began suddenly and persisted for three days , had been severe enough to warrant admission to the hospital .
after his discharge from the hospital , the pain recurred once a week , and sometimes lasted for several days .
physical examination at our institution ( westchester county medical center ) revealed inconsistent right upper quadrant tenderness with an occasional positive murphy 's sign .
all laboratory results were normal , including complete blood cell count , liver function tests and serum amylase .
initial ultrasound of the gallbladder done at a community hospital had revealed the presence of multiple small gallstones .
a repeat ultrasound examination demonstrated a 3 mm polypoid lesion in the body of the gallbladder , close to hartmann 's pouch ( figure 1 ) .
computerized tomography of the abdomen was normal , and failed to demonstrate the polypoid lesion in the gallbladder .
histological examination revealed a benign 2 mm adenomatous polyp in the body of the gallbladder , close to the hartmann 's pouch ( figure 2 ) .
after cholecystectomy the patient 's symptoms completely disappeared . he has remained well and pain - free after two years of follow - up .
polypoid lesions of the gallbladder have been the subject of controversy in the medical literature .
the most accepted classification was proposed by christensen and ishak , who classify the lesions as benign tumors , pseudotumors , and malignant neoplasms . over 90% of the polyps
adenomas of the gallbladder account for only 1% of all lesions , but they are important because of their potential transformation to invasive carcinoma .
it is characterized by late diagnosis and extremely poor prognosis with five - year survival of less than 5% .
the importance of early diagnosis is paramount in these cases , since the only survivors have been reported following early cholecystectomy .
polypoid lesions are mainly composed of heterotopic tissues , the most common one being ectopic gastric mucosa , followed by ectopic pancreatic and thyroid tissue . in our search of the literature we did not find any reports of adenomas of the gallbladder in children . for diagnostic purposes
, ultrasound seems to have the best sensitivity and specificity . computerized tomography with oral cholecystographic enhancement has been reported to be successful in equivocal cases . in the present case computerized tomography failed to demonstrate the polyp . in the adult population , accepted indications for cholecystectomy in the presence of polypoid lesions of the gallbladder include polyps over 10 mm in diameter , patient age over 50 years , sessile polyps , associated gallstones , possibility of malignancy and the presence of symptoms regardless of the size of the polyp . the experience with polypoid lesions of the gallbladder in children
however , because the presence of these lesions in the gallbladder of children has been associated with acalculous cholecystitis and because the long - term effects of their presence in the gallbladder are unknown , we currently recommend cholecystectomy in all children with such lesions .
laparoscopic cholecystectomy , which is now well accepted as a safe procedure in the pediatric population , even in small children , should be the procedure of choice unless there are specific contraindications for its use .
 polypoid lesions of the gallbladder in children are rare . 
 we report a case of a gallbladder polyp in a 14-year - old boy who presented with recurrent right upper quadrant abdominal pain . 
 ultrasound examination of the abdomen revealed a polypoid lesion of the gallbladder . 
 his symptoms resolved after laparoscopic cholecystectomy . 
 histological examination of the gallbladder demonstrated a benign adenomatous polyp . 
 although the experience with polypoid lesions of the gallbladder in children is limited , we currently recommend cholecystectomy because these lesions are associated with acalculous cholecystitis , and because their long - term effects are unknown . 
INTRODUCTION
CASE REPORT
DISCUSSION