19 Years Old Male Patient with Cholelithiasis: A Case Report

Main Article Content

Putu Bagus Aditya Putra Semara
Wangaya General Hospital
I Made Suma Wirawan
Universitas Mahasaraswati Denpasar

Cholelithiasis refers to the formation of hardened deposits of digestive fluid, known as gallstones, which can develop in the gallbladder, bile duct, or both. This study aims to analyze the factors contributing to the occurrence of cholelithiasis in young patients, specifically 19-year-old males, and identify the clinical symptoms and associated examination results. A 19-year-old male patient visited the Internal Medicine Polyclinic with the main complaint of right upper abdominal pain radiating to the back. He also experienced nausea and vomiting. The patient frequently consumed high-fat foods. On physical examination, the patient's height was 171 cm, weight 74 kg, and BMI 25.34 kg/m² (overweight). Abdominal examination revealed a positive Murphy's sign. Laboratory tests showed total cholesterol of 216 mg/dl, LDL 158 mg/dl, HDL 38 mg/dl, and triglycerides 86 mg/dl. An abdominal ultrasound indicated thickened gallbladder walls, a single stone measuring approximately 0.82 cm by 1.17 cm, accompanied by sludge, and calcification in the right lobe of the liver. The patient was treated with Ursodeoxycholic Acid (UDCA) 250 mg twice daily and Atorvastatin 10 mg once daily.   Cholelithiasis is a multifactorial condition, influenced by several factors, commonly referred to as the "4F" factors: female gender, age over 40, fertility (being in the fertile period), and fat (obesity). Other contributing factors include age, genetics, and race. Children and adolescents may develop gallstones due to increased consumption of fat, refined carbohydrates, and low fiber intake. Overweight and obesity are significant risk factors because they increase the secretion of intrahepatic cholesterol, which promotes gallstone formation. The treatment of cholelithiasis can be classified into non-surgical and surgical approaches.


Keywords: cholelithiasis, risk factors, obesity
Adhata, A. R., Mustofa, S., & Soleha, T. U. (2022). Diagnosis dan Tatalaksana Kolelitiasis. Medical Profession Journal of Lampung, 12(1), 75–78. https://doi.org/10.53089/medula.v12i1.401
Ali, A., Perveen, S., Khan, I., Ahmed, T., Nawaz, A., & Rab, A. (2021). Symptomatic Gallstones in Young Patients Under the Age of 30 Years. Cureus, 13(11), 25–30. https://doi.org/10.7759/cureus.19894
Bojazyah, A., & Bohlala, M. O. (2024). Evolving Patterns of Gallbladder Diseases in the Young Population: A Retrospective Study at Al Wahda Teaching Hospital, Derna, Libya. Journal of Archives in Military Medicine, 12(2), 50–55. https://doi.org/10.5812/jamm-145923
Dewi, Y. S., & Yusmaidi. (2024). Sebuah Laporan Kasus: Cholelithiasis dengan Cholesystitis Akut pada Laki-Laki 27 Tahun. Medula, 14(3), 447–453.
Diez, S., Müller, H., Weiss, C., Schellerer, V., & Besendörfer, M. (2021). Cholelithiasis and cholecystitis in children and adolescents: Does this increasing diagnosis require a common guideline for pediatricians and pediatric surgeons? BMC Gastroenterology, 21(1), 1–10. https://doi.org/10.1186/s12876-021-01772-y
Frybova, B., Drabek, J., Lochmannova, J., Douda, L., Hlava, S., Zemkova, D., Mixa, V., Kyncl, M., Zeman, L., Rygl, M., & Keil, R. (2018). Cholelithiasis and choledocholithiasis in children; risk factors for development. PLoS ONE, 13(5), 1–11. https://doi.org/10.1371/journal.pone.0196475
Hall, L., Halle-Smith, J., Evans, R., Toogood, G., Wiggins, T., Markar, S. R., Kapoulas, S., Super, P., Tucker, O., & McKay, S. C. (2023). Ursodeoxycholic acid in the management of symptomatic gallstone disease: systematic review and clinician survey. BJS Open, 7(2), 1–10. https://doi.org/10.1093/bjsopen/zrac152
Hendarto, H., Akbar, F. N., Muzakki, J. B., Amri, R. A., Nugraha, S. N. A., & Adlani, H. (2023). Obesity, dyslipidemia, and diabetes mellitus as risk factors in cholelithiasis. Electronic Journal of General Medicine, 20(6). https://doi.org/10.29333/ejgm/13814
Kazi, F. N., Ghosh, S., Sharma, J. V. P., Saravanan, S., & Patil, S. (2022). Trends in Gallbladder Disease in Young Adults: A Growing Concern. Cureus, 14(January 2020). https://doi.org/10.7759/cureus.28555
Kristianus, D., Setijoso, R. E., Mayasari, M., & Koncoro, H. (2022). Nyeri Epigastrik sebagai Presentasi Awal Kolelitiasis. Cermin Dunia Kedokteran, 49(11), 620–623. https://doi.org/10.55175/cdk.v49i11.316
Kumar, N. (2016). Study of Clinical Features and Management of Cholelithiasis. Rajiv Gandhi University of Health Sciences (India).
Lammert, F., Gurusamy, K., Ko, C. W., Miquel, J.-F., Méndez-Sánchez, N., Portincasa, P., Van Erpecum, K. J., Van Laarhoven, C. J., & Wang, D. Q.-H. (2016). Gallstones. Nature Reviews Disease Primers, 2(1), 1–17.
Littlefield, A., & Lenahan, C. (2019). Cholelithiasis: presentation and management. Journal of Midwifery & Women’s Health, 64(3), 289–297.
Lysandra, A. Z., Putri Wairooy, N. A., Ifadha, R. T., Ramainaldo S., A. A., Albright, I. A., Izzah, A. F., Rahma M., V. N., & Lestari, P. (2022). Risk Factor of Dietary Habit with Cholelithiasis. Journal of Community Medicine and Public Health Research, 3(1), 1–11. https://doi.org/10.20473/jcmphr.v3i1.27931
Shabanzadeh, D. M., Holmboe, S. A., Sørensen, L. T., Linneberg, A., Andersson, A. M., & Jørgensen, T. (2017). Are incident gallstones associated to sex-dependent changes with age? A cohort study. Andrology, 5(5), 931–938. https://doi.org/10.1111/andr.12391
Sun, H., Warren, J., Yip, J., Ji, Y., Hao, S., Han, W., & Ding, Y. (2022). Factors Influencing Gallstone Formation: A Review of the Literature. Biomolecules, 12(4), 1–13. https://doi.org/10.3390/biom12040550
Swarne, E., Srikanth, M. S., Shreyas, A., Desai, S., Mehdi, S., Gangadharappa, H. V, & Krishna, K. L. (2021). Recent advances, novel targets and treatments for cholelithiasis; a narrative review. European Journal of Pharmacology, 908, 174376.
Zdanowicz, K., Daniluk, J., Lebensztejn, D. M., & Daniluk, U. (2022). The Etiology of Cholelithiasis in Children and Adolescents—A Literature Review. International Journal of Molecular Sciences, 23(21). https://doi.org/10.3390/ijms232113376
Zeng, D., Wu, H., Huang, Q., Zeng, A., Yu, Z., & Zhong, Z. (2021). High Levels of Serum Triglyceride, Low-density Lipoprotein Cholesterol, Total Bile Acid, and Total Bilirubin are Risk Factors for Gallstones. Clinical Laboratory, 8.