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Acute Pancreatitis in Childhood: A 10-Year Experience From A Thai University Surgical Center
Ampaipan Boonthai1, Pornthep Tanpowpong2, Chawintee Puttanapitak1
1From the Division of Pediatric Surgery, Department of Surgery.
Insights
Pediatric acute pancreatitis is often caused by medications. Mortality is higher in boys and those with prior illnesses, indicating a need for targeted interventions in high-risk children.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Pediatrics
Background:
- Acute pancreatitis in children is a serious condition with varied etiologies and outcomes.
- Understanding the specific factors contributing to pediatric acute pancreatitis is crucial for effective management.
Purpose of the Study:
- To describe the etiology, management, and health outcomes of pediatric acute pancreatitis.
- To identify risk factors associated with mortality in children with acute pancreatitis.
Main Methods:
- Retrospective analysis of medical records of pediatric patients diagnosed with acute pancreatitis between 2006 and 2016.
- Data collected included patient demographics, etiology, clinical presentation, management, complications, and outcomes.
Main Results:
- Medications were the most common cause (39.3%), followed by biliary tract disease (11.4%).
- Elevated serum lipase was observed in 78.5% of patients; pseudocysts and necrotizing pancreatitis were the main complications.
- The overall mortality rate was 28%, significantly higher in males and patients with pre-existing illnesses.
Conclusions:
- Pediatric acute pancreatitis carries a significant mortality risk, particularly in male patients and those with comorbidities.
- Targeted management strategies for high-risk pediatric populations may help reduce mortality rates.
Objectives:
This study aimed to describe etiology, management, and health outcomes of children developing acute pancreatitis at a tertiary Thailand pediatric surgery center.
Methods:
Medical case records of all index cases during 2006-2016 were analyzed and reported.
Results:
There were 42 male and 37 female patients, with a mean (standard deviation) age of 10.4 (4.5) years, included in the study. Medications were the commonest etiology for 39.3% of acute pancreatitis attacks, 11.4% for biliary tract disease cases, and 8% for postinterventional studies. In 30% of cases, no cause(s) was defined. Sixty-two patients (78.5%) had elevated serum lipase on hospital admission, whereas only 30.4% showed a raised amylase. Hospital stay was 15 days (interquartile range, 6-27 days). Two major complications in the series were pseudocysts (8.8%) and necrotizing pancreatitis (7.6%). Etiological factors and/or antibiotics were not directly linked to any specific complications. Seventeen children (22.8%) had 1 recurrent episode of acute pancreatitis documented. Mortality rate in index cases was 28%, with a higher percentage harboring a preexisting illness (34.4% vs 5.6%; P = 0.01) and in male than in female patients (41% vs 14%; P = 0.01).
Conclusions:
Deaths from pediatric acute pancreatitis are more prevalent in male individuals and those with a preexisting illness. Targeted strategies aimed at "highest-risk" patients may potentially offset mortality.
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