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Paediatric acute pancreatitis: Clinical profile and natural history of collections
Sadhna B Lal1, Vybhav Venkatesh1, Surinder S Rana2
1Division of Paediatric Gastroenterology, Hepatology & Nutrition, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India.
Insights
Acute pancreatitis in children often presents as moderately severe. Collections like pancreatic fluid collections and necrotic collections can evolve into pseudocysts or walled-off necrosis, requiring intervention in some cases.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Pancreatology
Background:
- Acute pancreatitis (AP) in children typically follows a benign course.
- Limited data exists on AP severity, collection types (pseudocyst, walled-off necrosis), and their outcomes in pediatric patients.
Purpose of the Study:
- To investigate the severity spectrum of AP in children.
- To categorize pancreatic collections (acute pancreatic fluid collections, acute necrotic collections) and analyze their natural history and outcomes.
- To evaluate the need for intervention in pediatric AP complications.
Main Methods:
- Retrospective review of medical records for 187 children diagnosed with pancreatitis.
- Analysis of AP severity, types of collections, and their evolution.
- Assessment of intervention rates and methods (percutaneous catheter drainage, endoscopic ultrasound-guided drainage).
Main Results:
- 101 children had AP, with 60.4% classified as moderately severe.
- 61.4% of patients had pancreatic fluid collections (PFC) at diagnosis.
- Acute pancreatic fluid collections evolved into pseudocysts in 52.3%, and acute necrotic collections into walled-off necrosis in 68.2%.
Conclusions:
- Moderately severe AP is prevalent in hospitalized children.
- A significant proportion of pancreatic fluid collections and acute necrotic collections progress to pseudocysts or walled-off necrosis.
- Spontaneous resolution is more common in non-traumatic AP with pseudocysts compared to walled-off necrosis.
Background & Aims:
Acute Pancreatitis (AP) tends to have a benign course in children. However there is a paucity of information with respect to severity of AP in children, the categorization of collections viz., walled off necrosis (WON)& pseudocyst and their natural history & outcomes.
Methods:
A retrospective medical record review of 187 children with pancreatitis diagnosed and managed at our centre was performed.
Results:
101 children (59% boys, Median age 9yrs) had AP of which 37.6%, 60.4% and 2% had mild, moderately severe and severe AP. 61.4%(62) had PFC at diagnosis; 34%(21) acute pancreatic fluid collections (APFC) and 66%(41) acute necrotic collections (ANC). 52.3%(11of21) of APFC evolved into pseudocysts & 68.2%(28of41) of ANC into WON's. Drainage was required in 31%(12of39) of persisting collections, more frequently in children with traumatic AP. Percutaneous catheter drainage (PCD) was done in 6 children and endoscopic ultrasound (EUS) guided cystogastrostomy with placement of plastic or self expanding metal stents (SEMS) in 6 children.
Conclusions:
Moderately severe AP is common in hospitalized children with AP with PFC developing in 61.4%, majority being APFC. 48% of APFC and 32% of ANC will resolve and the rest evolve into pseudocyst or WON. Spontaneous resolution is more likely in children with non -traumatic AP having pseudocysts rather than WON's.
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