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Surgical disorders of the pancreas in infancy and childhood
A Y Synn1, S J Mulvihill, E W Fonkalsrud
1Division of Pediatric Surgery, UCLA School of Medicine.
Insights
This 20-year review of pediatric pancreatic disorders found pancreatitis and congenital malformations were most common. Nonoperative treatment for pancreatitis had a 17% mortality, highlighting the need for careful management of these rare pediatric conditions.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Pediatric Endocrinology
Background:
- Pancreatic disorders in children are uncommon but can be complex.
- A comprehensive review of pediatric pancreatic conditions over two decades provides valuable insights.
Purpose of the Study:
- To review and analyze the spectrum of pancreatic disorders in infants and children over a 20-year period.
- To evaluate treatment outcomes and identify predominant types and complications.
Main Methods:
- Retrospective review of 79 pediatric patients treated for pancreatic disorders.
- Categorization of disorders including pancreatitis, congenital malformations, hypoglycemia/hyperinsulinism, and carcinoma.
- Analysis of treatment modalities (operative vs. nonoperative) and outcomes.
Main Results:
- Pancreatitis (48 cases) and congenital malformations (17 cases) were the most frequent diagnoses.
- Idiopathic and drug-induced pancreatitis (corticosteroids) predominated; nonoperative pancreatitis had a 17% mortality.
- Congenital anomalies like annular pancreas and ectopic pancreas were successfully treated with surgery.
- Surgical resection for nesidioblastosis, islet cell hyperplasia, and adenomas yielded good results, though neurologic sequelae occurred.
- Two pancreatic carcinoma cases underwent radical resection with one long-term survivor.
Conclusions:
- Pancreatic disorders in children are rare but diverse, requiring specialized management.
- Nonoperative management of pancreatitis in children is associated with significant mortality.
- Surgical interventions for congenital pancreatic malformations and neoplasms can be highly effective.
- Early diagnosis and appropriate treatment are crucial for improving outcomes in pediatric pancreatic diseases.
Abstract:
Pancreatic disorders in infants and children encountered over a 20 year period are reviewed. A total of 79 children were treated. Forty-eight had pancreatitis or its complications, 17 had congenital malformations, 12 had hypoglycemia and hyperinsulinism, and 2 had carcinoma. The mortality rate for the children with pancreatitis was 17 percent and was limited to patients treated nonoperatively. Idiopathic and drug-induced pancreatitis (the latter, particularly from corticosteroids) were the predominant types. Only rarely should such patients undergo operative treatment. Operations performed for various obstructive or traumatic lesions of the pancreas, as well as for complications of pancreatitis, obtained uniformly good results. The most common congenital malformation of the pancreas was an annular pancreas in association with duodenal atresia; all children with this abnormality were successfully treated with bypass procedures. Four patients with an ectopic pancreas underwent successful wedge resection. Nine infants with nesidioblastosis or islet cell hyperplasia and three children with islet cell adenomas underwent successful resection without any deaths, although neurologic sequelae due to prolonged preoperative hypoglycemia were common. Two patients underwent radical resection for pancreatic carcinoma, one of whom had survived 20 years postoperatively at last follow-up. Pancreatic disorders requiring operation in childhood are uncommon, but are likely to be complex and challenging when they do occur.