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Continuous regional arterial infusion effective for children with acute necrotizing pancreatitis even under

Hiroko Fukushima1, Takashi Fukushima, Ryoko Suzuki

  • 1Department of Pediatrics, University of Tsukuba Hospital, University of Tsukuba, Tsukuba, Japan.

Pediatrics International : Official Journal of the Japan Pediatric Society
|May 18, 2013
PubMed

Insights

Severe acute pancreatitis is a critical complication in pediatric cancer patients. Continuous regional arterial infusion of antibiotics and protease inhibitors offers a promising, effective treatment, even during agranulocytosis.

Area of Science:

  • Pediatric Oncology
  • Gastroenterology
  • Critical Care Medicine

Background:

  • Severe acute pancreatitis (SAP) is a life-threatening complication in pediatric cancer patients, particularly those undergoing chemotherapy or hematopoietic transplantation.
  • Infectious pancreatitis and circulatory collapse are leading causes of mortality in SAP.
  • Patients with malignancy and neutropenia are at high risk for fatal SAP.

Observation:

  • Three pediatric cancer patients with neutropenia developed severe acute pancreatitis.
  • Two patients with severe conditions, including agranulocytosis, were treated with continuous regional arterial infusion (CRAI) of a protease inhibitor and antibiotic.
  • One patient received conventional intravenous antibiotic and protease inhibitor therapy with parenteral nutrition.

Findings:

  • Continuous regional arterial infusion (CRAI) treatment resulted in earlier symptom resolution compared to conventional therapy, despite more severe initial conditions.
  • Both CRAI-treated patients showed successful recovery.
  • The patient on conventional therapy also recovered, but with a longer resolution time.

Implications:

  • Severe acute pancreatitis is a significant complication in childhood malignancy.
  • Continuous regional arterial infusion (CRAI) of protease inhibitors and antibiotics is a well-tolerated and effective treatment for SAP in neutropenic pediatric cancer patients.
  • This approach may reduce early mortality associated with pancreatitis in this vulnerable population.

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