Pancreatic ductal abnormalities in children

From 1979 to 1990, 33 children required operative treatment for pancreatitis. Causes included ductal abnormalities (12 children), trauma (10 children), idiopathic (four children), gallstones (three children), drug-induced (three children), and tumor (one child). This study reviews the characteristics and outcome of the 12 children with ductal abnormalities. Symptoms were present up to 9 years or less before diagnosis, with two patients undergoing negative appendectomies. At diagnosis, amylase levels averaged 612 IU/L and lipase, 4761 IU/L. Preoperative studies included ultrasonography (11 children), endoscopic retrograde cholangiopancreatography (nine children), and computerized tomography (six children). Intraoperative cholangiopancreatography was performed in nine patients and was essential in four to diagnosis their anomaly. Patients were categorized into those with a common channel (three children), ampullary stenosis (two children), ductal fusion error (one child), or combinations (six children). Operations included sphincteroplasty (seven patients), pancreaticobiliary separation (six patients), pancreatic duct enterostomy (three patients), and distal pancreatectomy (one patient). Three patients required more than one procedure to repair the combination anomalies. Symptoms resolved immediately in nine patients. Two patients had delayed resolution, with one patient requiring the addition of somatostatin. One patient was lost to follow-up. Recurrent or protracted pancreatitis, without obvious cause, requires expeditious endoscopic retrograde cholangiopancreatography and/or intraoperative cholangiopancreatography. Operative therapy should be tailored to ductal anatomy and will resolve symptoms in most children.