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Acute Pancreatitis in Children
1Gastroenterology Section, Department of Pediatrics, The Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, USA. swerlin@mcw.edu
Insights
Current pancreatitis treatments focus on supportive care and managing complications, as no cure exists. For severe cases, interventions like antibiotics and surgical debridement improve survival rates.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Gastroenterology
Background:
- Pancreatitis lacks curative therapies, necessitating supportive and expectant management for mild to moderate cases.
- Severe pancreatitis involves local, systemic, and septic complications requiring intensive treatment.
Purpose of the Study:
- To outline current treatment strategies for mild, moderate, and severe pancreatitis.
- To highlight the role of supportive care, complication management, and emerging surgical approaches.
Main Methods:
- Supportive care: pain relief, fluid/electrolyte balance, nutritional support (enteral/parenteral feeding).
- Interventions for biliary pancreatitis: Endoscopic retrograde cholangiopancreatography (ERCP) for stone extraction.
- Management of severe pancreatitis: Intravenous antibiotics, selective bowel decontamination, surgical debridement, necrosectomy, and lavage.
Main Results:
- Supportive care is the mainstay for 85% of pancreatitis cases.
- Antibiotics and selective bowel decontamination reduce mortality in severe pancreatitis.
- Emerging evidence suggests necrosectomy and lavage improve survival over traditional resection and drainage.
Conclusions:
- Pancreatitis treatment is primarily supportive, focusing on homeostasis and complication management.
- While no cure exists, interventions like antibiotics and advanced surgical techniques enhance outcomes in severe disease.
- The consensus is shifting towards necrosectomy and lavage for improved survival in severe pancreatitis.
Abstract:
There are no drugs that cure or abate pancreatitis. The treatment of patients with mild and moderate episodes of pancreatitis (85%) is supportive and expectant. Central issues include the removal of the initiating process (if possible), relief of pain, and maintenance of fluid and electrolyte balance. Endoscopic retrograde cholangiopancreatography may be required for stone extraction in patients with biliary pancreatitis. Surgery is rarely required. The aims of treatment for patients with severe disease includes treatment of local, systemic, and septic complications in addition to those for mild and moderate disease. Homeostasis is maintained by the correction of hypocalcemia, anemia, hypoalbuminemia, electrolyte imbalances, and hypoxemia. A large number of medications have been used unsuccessfully in an attempt to halt the progression of the autodigestive process within the pancreas and to reduce pancreatic secretions. Nutritional support with either enteral or parenteral feeding is given. Intravenous antibiotics or selective bowel decontamination decrease mortality in patients with severe episodes of pancreatitis. The treatment for these individuals is often prolonged. Surgical treatment of traumatic pancreatitis with ductal rupture includes repair or resection. At times, simple drainage is performed and definitive surgery is deferred until later. Surgical treatment of severe pancreatitis includes debridement of necrotic and infected tissue. The emerging consensus appears to be that necrosectomy and local lavage or open management with planned re-exploration offers better survival than the conventional therapy of resection plus drainage alone.