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Acute Pancreatitis and Acute Recurrent Pancreatitis in Children: Imaging Findings and Outcomes
Ercan Ayaz1, Hatice Nursun Özcan1, Hayriye Hızarcıoğlu Gülşen2
1Division of Pediatric Radiology, Department of Radiology, Hacettepe University, School of Medicine, Ankara, Turkey.
Insights
Pediatric acute pancreatitis imaging is crucial. Magnetic resonance imaging (MRI) offers better detection of complications than ultrasound, especially for acute recurrent pancreatitis.
Area of Science:
- Pediatric Gastroenterology and Radiology
- Medical Imaging in Children
- Pancreatic Diseases
Background:
- The incidence of acute pancreatitis and acute recurrent pancreatitis in children is rising.
- Limited data exists on the specific imaging findings in pediatric cases.
- Accurate diagnosis and characterization are vital for effective management.
Purpose of the Study:
- To determine the imaging findings of acute pancreatitis and acute recurrent pancreatitis in children.
- To compare the diagnostic utility of different imaging modalities.
- To identify common causes and complications in this pediatric population.
Main Methods:
- Retrospective analysis of 74 pediatric patients diagnosed between 2007 and 2018.
- Evaluation of initial and follow-up imaging features, including pancreatic size, fluid collections, and ductal changes.
- Correlation of imaging findings with clinical data and causes.
Main Results:
- Common causes included biliary anomalies, stones, and cystic fibrosis.
- Magnetic resonance imaging (MRI) detected findings in 60% of cases, compared to 40.5% for ultrasound.
- MRI identified abnormalities missed by ultrasound in 41% of patients; 32 patients had acute recurrent pancreatitis.
Conclusions:
- Recognizing imaging findings of pediatric acute pancreatitis and its complications is essential.
- MRI is a valuable second-line imaging modality after ultrasound for better delineation of biliary ducts and complications.
- Timely and accurate imaging aids in the management of pediatric pancreatitis.
Objective:
The prevalence of acute pancreatitis and acute recurrent pancreatitis in children has increased over the years, and there are limited data about imaging findings. This study aimed to reveal the imaging findings of acute pancreatitis and acute recurrent pancreatitis in children at a tertiary care hospital.
Materials And Methods:
The patients with acute pancreatitis and acute recurrent pancreatitis diagnosed between January 2007 and December 2018 were included. Demographic and clinical features, follow-up period, and interventions were noted. Imaging features were evaluated for pancreatic enlargement, peripancreatic fluid, and biliary ducts for initial examination and pancreas parenchymal necrosis, peripancreatic collection, walled-off necrosis, pseudocyst, parenchymal atrophy, and biliary ductal dilatation for follow-up.
Results:
The study included 74 patients with a mean age of 9 ± 4.9 years. The most common causes of acute pancreatitis and acute recurrent pancreatitis were biliary tract anomalies (n = 21), biliary ductal stones (n = 9), and cystic fibrosis (n = 8). Findings consistent with acute pancreatitis were determined by ultrasound in 40.5% (n = 30/74), whereas by magnetic resonance imaging in 60% (n = 39/65). Forty-one percent of the patients (n = 16) with positive magnetic resonance imaging findings did not show any findings on ultrasound. Acute recurrent pancreatitis was seen in 32 patients (43.2%). Follow-up imaging was performed in 55 patients (74.3%) between 2 months and 11 years. At follow-up, 8 patients had peripancreatic collections (6 walled-off necrosis and 2 pseudocysts).
Conclusion:
Recognizing the imaging findings of acute pancreatitis and its complications is crucial. Magnetic resonance imaging should be preferred as a second option following ultrasound, with the advantages of biliary ductal system delineation and better characterization of complications.
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