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Acute and chronic pancreatitis
1Department of Paediatric Surgery, King's College Hospital, London, UK. markdav2@aol.com
Insights
Childhood pancreatitis, often overlooked, is diagnosed by elevated amylase. Common causes include ductal abnormalities, infections, and trauma, requiring imaging for surgical planning.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Surgical Gastroenterology
Background:
- Pancreatitis in children is frequently underdiagnosed despite simple diagnostic criteria.
- Pediatric pancreatitis etiology differs significantly from adult cases, with structural ductal anomalies being common.
- Potential causes include choledochal malformation, common pancreatobiliary channel, and pancreas divisum.
Purpose of the Study:
- To review the diagnosis and management of pancreatitis in children.
- To highlight the distinct causes of pediatric pancreatitis compared to adults.
- To discuss diagnostic modalities and treatment strategies for pediatric pancreatitis.
Main Methods:
- Diagnosis relies on elevated plasma amylase levels.
- Imaging techniques such as ultrasound, CT scanning, and ERCP are crucial for identifying underlying causes.
- Review of existing literature on pediatric pancreatitis causes, diagnosis, and management.
Main Results:
- Common causes in children include structural abnormalities (choledochal malformation, common pancreatobiliary channel, pancreas divisum), drug reactions, infections, and trauma.
- Imaging plays a key role in identifying patients needing surgical intervention.
- Acute pancreatitis can lead to systemic complications affecting renal and respiratory systems.
Conclusions:
- Pediatric pancreatitis requires specific consideration due to its unique etiological profile.
- Prompt diagnosis and appropriate imaging are essential for effective management and surgical planning.
- Minimally invasive techniques are often sufficient for managing complications like pseudocysts, though open surgery may be necessary in select cases.
Abstract:
Pancreatitis is under appreciated during childhood although its diagnosis is simple and management straightforward in most cases. There is a range of possible causes, which is quite different to the situation in adults. The commonest underlying problems are probably structural abnormalities of the pancreatic and biliary ducts such as choledochal malformation, common pancreatobiliary channel and pancreas divisum. Other causes, which can be important in certain groups and geographical areas, are those due to drug reactions, viral infection and parasitic infestation, and blunt abdominal trauma. The diagnosis is established by showing a significantly raised plasma amylase level. Other diagnostic tools such as ultrasound, computed tomography (CT) scanning and endoscopic retrograde cholangiopancreatography (ERCP) have a major role in determining possible underlying causes, and hence selecting out those who require definitive corrective surgery. The pathophysiology of pancreatitis remains to be fully elucidated and, in the acute phase can affect other organs such as the renal and respiratory systems. Later complications include sepsis, pancreatic abscess and typically pseudocyst formation. Most of these can be treated using minimally invasive techniques such as percutaneous aspiration although open surgical techniques such as cystgastrostomy may be required in a few.