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Identification of Causes and Diagnostic Difficulty in Managing Paediatric Pancreatitis: Experience at A Tertiary Care
K L Nahid1, M Rukunuzzaman, K Fathema
1Dr Khan Lamia Nahid, Associate Professor, Department of Paediatric Gastroenterology and Nutrition, Bangladesh Medical University (BMU), Dhaka, Bangladesh;
Insights
Pediatric pancreatitis, often idiopathic or biliary in origin, presents a diagnostic challenge. This study highlights the varied etiologies and complications of acute, recurrent, and chronic pancreatitis in children, noting management limitations.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Clinical Medicine
Background:
- Paediatric pancreatitis is a complex condition with diverse causes and diagnostic difficulties.
- Understanding the spectrum of pancreatitis in children is crucial for effective management.
Purpose of the Study:
- To investigate the etiology, clinical presentation, and outcomes of paediatric pancreatitis.
- To analyze the different types of pancreatitis including acute, acute recurrent, and chronic pancreatitis in a pediatric cohort.
Main Methods:
- A prospective, cross-sectional study involving 101 children (aged 4-17) diagnosed with pancreatitis.
- Classification of pancreatitis based on the International Study Group of Pediatric Pancreatitis criteria.
- Data collection on etiology, local complications, and long-term sequelae.
Main Results:
- Idiopathic causes predominated in acute pancreatitis (61.9%), followed by biliary abnormalities (21.0%).
- Chronic pancreatitis was frequently calcific (42.3% tropical calcific pancreatitis) and associated with diabetes mellitus and steatorrhea.
- Acute recurrent pancreatitis was predominantly idiopathic (72.7%). No mortality was observed in acute pancreatitis cases.
Conclusions:
- Idiopathic and biliary etiologies are common in paediatric acute pancreatitis.
- Chronic pancreatitis in this cohort often presented as calcific pancreatitis with significant complications.
- Therapeutic limitations, such as restricted ERCP use in young children, impacted management.
Abstract:
Paediatric pancreatitis remains a poorly diagnosed clinical entity with widely variable etiology. Children (up to 18 years of age) diagnosed with pancreatitis and treated in the department of Pediatric Gastroenterology of BMU, Dhaka, Bangladesh were included in this study. Over a period of 4 years (from January 2020 to February 2024), total 101 children were enrolled in this single center, prospective cross sectional study. Paediatric Pancreatitis: Acute pancreatitis (AP), acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) was defined by the International Study Group of Pediatric Pancreatitis: In Search for a Cure consortium. During the study period, a total of 101 cases of pancreatitis 42(41.6%) AP, 26(25.7%) ARP and 33(32.7%) CP was managed. The mean age of the study population was 10.38±3.7 (range- 4 to 17) years, with a male to female ratio of 51:50 (1.02:1). The etiology of AP included biliary 9(21.0%): 2 gallstones, 5 choledochal cyst, 2 biliary ascariasis; viral infection 2(4.8%): 1 Mumps, 1 Hepatitis A; drugs 3(7.2%): 2 L-asparaginase, 1 vincristine; trauma 1(2.3%), Hypertriglyceridemia 1(2.3%) and idiopathic 26(61.9%). Local complications of all pancreatitis cases: acute fluid collections in 5(4.95%), pseudocysts in 5(4.95%) and pancreatic ascites in 3(2.97%) cases. Almost half (11/26) of CP had calcific pancreatitis and the etiology of CP was tropical calcific pancreatitis in 11(42.3%), SPINK1/PRSS gene mutation in 2(7.2%), cystic fibrosis in 1(3.8%), trauma in 1(3.8%) and idiopathic in the remaining 11(42.0%) cases. Three (3.5%) patients with CP developed diabetes mellitus and 6(7.0%) patients had steatorrhea. The etiology of ARP was biliary in 6(18.0%) cases; 1 choledochal cyst, 4 gallstones, 1 biliary ascariasis), Hypertriglyceridemia in 2(6.0%), pancreas divisum in 1(3.0%) and idiopathic in 24(72.7%) cases. In this pediatric cohort, causes of acute pancreatitis were mostly idiopathic followed by biliary abnormality. There was no mortality in hospitalized patients of acute pancreatitis in our study. Half of chronic pancreatitis patients were calcific pancreatitis. As there was therapeutic limitation in performing ERCP in small children, proper management could not be given.
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